Provider Demographics
NPI:1821560475
Name:MARIA J. MYNATT, MD, PLLC
Entity type:Organization
Organization Name:MARIA J. MYNATT, MD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:JOSEPHINE
Authorized Official - Last Name:MYNATT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-325-5467
Mailing Address - Street 1:455 WOODLAWN AVE
Mailing Address - Street 2:
Mailing Address - City:GLENCOE
Mailing Address - State:IL
Mailing Address - Zip Code:60022-2175
Mailing Address - Country:US
Mailing Address - Phone:847-791-7799
Mailing Address - Fax:
Practice Address - Street 1:250 PARKWAY DR STE 150
Practice Address - Street 2:
Practice Address - City:LINCOLNSHIRE
Practice Address - State:IL
Practice Address - Zip Code:60069-4340
Practice Address - Country:US
Practice Address - Phone:847-325-5467
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-20
Last Update Date:2018-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty