Individual
DR. JELICA MAZE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
12750 ST FRANCIS DR STE 320, CROWN POINT, IN 46307-0264
(219) 662-0077
(219) 662-9496
Mailing address
PO BOX 781076, DETROIT, MI 48278-1076
(317) 528-4800
(317) 865-1479
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
01077479A
IN
207RC0000X
Cardiovascular Disease Physician
Primary
01077479A
IN
207RC0000X
Cardiovascular Disease Physician
036132452
IL
207RC0000X
Cardiovascular Disease Physician
MD445339
PA
207RC0000X
Cardiovascular Disease Physician
ME112860
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036132452
—
IL
01
—
1124399605
BCBS GROUP
IL
Enumeration date
04/23/2008
Last updated
01/12/2024
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