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Individual
MARA DIVIS
Active
Individual
MARA DIVIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DO
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
02003631A
IN
207Q00000X
Family Medicine Physician
Primary
036129431
IL
207Q00000X
Family Medicine Physician
58.002346
OH
Other
Enumeration date
02/26/2009
Last updated
04/11/2025
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