Provider Demographics
NPI:1760175129
Name:MAGGIOLINO MEDICAL, S.C.
Entity Type:Organization
Organization Name:MAGGIOLINO MEDICAL, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:DANA
Authorized Official - Last Name:FOGGETTI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:630-514-9297
Mailing Address - Street 1:840 S WAUKEGAN RD STE 102
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60045-2616
Mailing Address - Country:US
Mailing Address - Phone:630-514-9297
Mailing Address - Fax:
Practice Address - Street 1:840 S WAUKEGAN RD STE 102
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:IL
Practice Address - Zip Code:60045-2616
Practice Address - Country:US
Practice Address - Phone:630-514-9297
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-01
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty