Individual
DR. THERESA MAICKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
8420 W BRYN MAWR AVE STE 300, CHICAGO, IL 60631-3436
(708) 831-8282
(773) 714-1229
Mailing address
PO BOX 443, BEDFORD PARK, IL 60499-0443
(708) 831-8282
(773) 714-1229
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
036093939
IL
208VP0014X
Interventional Pain Medicine Physician
036093939
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036093939
—
IL
Enumeration date
05/03/2006
Last updated
06/24/2021
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