Individual
MISS TALIA MAVROGIANNIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2160 S 1ST AVE, MAYWOOD, IL 60153-3328
(708) 216-9122
Mailing address
2160 S 1ST AVE, MAYWOOD, IL 60153-3328
(708) 216-9122
Taxonomy
Speciality
Code
Description
License number
State
207XX0004X
Orthopaedic Foot and Ankle Surgery Physician
085.008933
IL
363A00000X
Physician Assistant
Primary
085008933
IL
Other
Enumeration date
03/21/2022
Last updated
01/29/2025
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