Provider Demographics
NPI:1801821582
Name:PAES, MAURO (MD)
Entity Type:Individual
Prefix:
First Name:MAURO
Middle Name:
Last Name:PAES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2525 S MICHIGAN AVE
Mailing Address - Street 2:12TH FLR
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616-2333
Mailing Address - Country:US
Mailing Address - Phone:312-567-2380
Mailing Address - Fax:312-328-7739
Practice Address - Street 1:2525 S MICHIGAN AVE
Practice Address - Street 2:12TH FLR
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-2333
Practice Address - Country:US
Practice Address - Phone:312-567-6691
Practice Address - Fax:312-328-7895
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036048028 01Medicaid
IL01621679OtherBCBS
ILK22102Medicare PIN
IL036048028 01Medicaid
ILK22589Medicare PIN