Individual
MAOXIIM TELLEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1 CENTRE DR, PETERSBURG, IL 62675-9467
(217) 632-7761
(217) 632-0312
Mailing address
PO BOX 3428, SPRINGFIELD, IL 62708-3428
(800) 577-5368
(217) 757-2021
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036117662
IL
Other
Enumeration date
03/08/2007
Last updated
11/03/2022
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