Individual
MARY THERESE UCKERMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
701 W NORTH AVE, MELROSE PARK, IL 60160-1612
(708) 681-3200
Mailing address
701 W NORTH AVE, MELROSE PARK, IL 60160-1612
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
036087252
IL
207ZP0105X
Clinical Pathology/Laboratory Medicine Physician
036087252
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01623819
BLUE SHIELD ILLINOIS
IL
05
—
036087252
—
IL
Enumeration date
08/14/2006
Last updated
09/05/2023
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