Individual
ADAM JAMES MAYBERRY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
1500 S FAIRFIELD AVE, CHICAGO, IL 60608-1782
(312) 498-6037
Mailing address
3051 W LYNDALE ST, CHICAGO, IL 60647-2811
(312) 498-6037
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
085007405
IL
Other
Enumeration date
01/27/2020
Last updated
01/27/2020
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