Organization
THIDA MAW MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THIDA MAW MD (OWNER / PHYSICIAN)
(847) 428-1179
Entity
Organization
Contact information
Practice address
2201 RANDALL RD, CARPENTERSVILLE, IL 60110-3355
(847) 428-1179
Mailing address
2201 RANDALL RD, CARPENTERSVILLE, IL 60110-3355
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0004532040
BCBS
IL
Enumeration date
05/26/2006
Last updated
07/14/2008
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