Individual
MAHVEEN ETHEZAZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
908 N ELM ST STE 103, HINSDALE, IL 60521-3635
(630) 789-8890
(630) 789-8892
Mailing address
PO BOX 713260, CHICAGO, IL 60677-1260
(630) 469-9200
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036-151954
IL
207Q00000X
Family Medicine Physician
61445
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036151954
—
IL
Enumeration date
04/01/2014
Last updated
08/29/2023
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