Provider Demographics
NPI:1124071139
Name:LENTZOU, MARIA (MD)
Entity type:Individual
Prefix:DR
First Name:MARIA
Middle Name:
Last Name:LENTZOU
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 1:12050 S HARLEM AVENUE, UNIT A
Mailing Address - Street 2:
Mailing Address - City:PALOS HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60463-1141
Mailing Address - Country:US
Mailing Address - Phone:708-671-1500
Mailing Address - Fax:708-671-1535
Practice Address - Street 1:12050 S HARLEM AVE STE A
Practice Address - Street 2:
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463-2803
Practice Address - Country:US
Practice Address - Phone:708-671-1500
Practice Address - Fax:708-671-1535
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-19
Last Update Date:2011-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036100946207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H38671Medicare UPIN