Provider Demographics
NPI:1851510416
Name:MATHIAS, MARY-ANN M (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY-ANN
Middle Name:M
Last Name:MATHIAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:670 W WAYMAN ST
Mailing Address - Street 2:1203
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60661-1704
Mailing Address - Country:US
Mailing Address - Phone:773-988-3151
Mailing Address - Fax:312-291-9842
Practice Address - Street 1:1588 N. ARLINGTON HEIGHTS ROAD
Practice Address - Street 2:ARLINGTON HEIGHTS
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004
Practice Address - Country:US
Practice Address - Phone:847-392-9220
Practice Address - Fax:847-392-9252
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125047242207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK41045Medicare UPIN