Provider Demographics
NPI:1851786669
Name:COLLISON, MAGGIE (MD)
Entity Type:Individual
Prefix:
First Name:MAGGIE
Middle Name:
Last Name:COLLISON
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 1:2050 PFINGSTEN RD STE 360
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60026-1313
Mailing Address - Country:US
Mailing Address - Phone:847-657-5959
Mailing Address - Fax:847-657-5764
Practice Address - Street 1:2050 PFINGSTEN RD STE 360
Practice Address - Street 2:
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60026-1313
Practice Address - Country:US
Practice Address - Phone:847-657-5959
Practice Address - Fax:847-657-5764
Is Sole Proprietor?:No
Enumeration Date:2015-03-30
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036146121207RI0200X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program