Theodore Mazzone

NPI 1962515403 - Internal Medicine - 207RE0101X

NPI Details
NPI 1962515403
Gender Male
Enumeration Date 08/17/2006
Last Updated 06/23/2008
Entity Type Individual
Active Over 10 years ago
Practice Location
1740 W TAYLOR ST
CHICAGO IL, 60612-7232, US
Phone (866) 600-2273
Fax
Business Location
1819 W POLK ST
612 CMW, MC 797
CHICAGO IL, 60612-4356, US
Phone (312) 996-7989
Fax (312) 413-0437
Toxanomy
Taxonomy Code 207RE0101X
License State Illinois
License Number 036066566
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According to our database, Theodore Mazzone NPI is 1962515403, taxonomy code is 207RE0101X and license number is 036066566, license state is located at Illinois. Theodore Mazzone physically located at 1740 W Taylor St, Chicago IL, 60612-7232. NPI Number Theodore Mazzone has the Individual type.

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1962515403 NPI number is provided on an as is basis without warranty of any kind. 1962515403 is maintained by the National Plan & Provider Enumeration System. The contents of Theodore Mazzone are for informational purposes only.