Provider Demographics
NPI:1750316774
Name:MAISH, MARY S (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:S
Last Name:MAISH
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:800 N WESTMORELAND RD STE 100
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60045-1671
Mailing Address - Country:US
Mailing Address - Phone:224-271-4650
Mailing Address - Fax:224-234-4336
Practice Address - Street 1:800 N WESTMORELAND RD STE 100
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:IL
Practice Address - Zip Code:60045-1671
Practice Address - Country:US
Practice Address - Phone:224-271-4650
Practice Address - Fax:224-234-4336
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2018-12-05
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Provider Licenses
StateLicense IDTaxonomies
IL036147674208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G868960Medicaid
CAWG86896BMedicare PIN
CAH86896BMedicare UPIN