Provider Demographics
NPI:1790766681
Name:SY, MARIA ENGRACIA R (MD)
Entity Type:Individual
Prefix:
First Name:MARIA ENGRACIA
Middle Name:R
Last Name:SY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:7926 PRESTON HWY STE 106
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40219
Practice Address - Country:US
Practice Address - Phone:502-964-4357
Practice Address - Fax:502-966-5948
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2021-12-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AK7165207Q00000X
KY33438207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY080113207OtherRAILROAD MEDICARE
KY64433386Medicaid
KYG62887Medicare UPIN
KY0216334Medicare ID - Type Unspecified