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Individual

MAURICE W BIRT

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
25 WINFIELD ROAD, WINFIELD, IL 60190-1295
(630) 260-0600
(630) 260-1370
Mailing address
25 WINFIELD ROAD, WINFIELD, IL 60190-1295
(630) 260-0600
(630) 260-1370

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036078879
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0222075
BLUE CROSS NUMBER
IL
05
036078879
IL
01
363149833
TAX IDENTIFICATION NUMBER
IL
01
3631498336019001
CDPG HFS PAYEE ID
IL
Enumeration date
07/04/2006
Last updated
04/02/2013
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