Provider Demographics
NPI:1427127505
Name:PASCIAK, MARY THERESE (MD)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:THERESE
Last Name:PASCIAK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:133 E BRUSH HILL RD
Mailing Address - Street 2:STE 205
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-5659
Mailing Address - Country:US
Mailing Address - Phone:331-221-9605
Mailing Address - Fax:331-221-3828
Practice Address - Street 1:133 E BRUSH HILL RD
Practice Address - Street 2:STE 205
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-5659
Practice Address - Country:US
Practice Address - Phone:331-221-9605
Practice Address - Fax:331-221-3828
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2016-03-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036066600207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036066600Medicaid
31602800OtherBCBS
D15573Medicare UPIN
D15573Medicare UPIN