Individual
THEA MAUCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5841 S MARYLAND AVE, CHICAGO, IL 60637-1443
(888) 824-0200
Mailing address
150 HARVESTER DR STE 300, BURR RIDGE, IL 60527-5965
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085012104
IL
363A00000X
Physician Assistant
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
10/07/2024
Last updated
04/01/2026
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