Provider Demographics
NPI:1245540418
Name:ITUARTE, MAIDER
Entity type:Individual
Prefix:MRS
First Name:MAIDER
Middle Name:
Last Name:ITUARTE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5050 N SHERIDAN RD APT 312
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-3181
Mailing Address - Country:US
Mailing Address - Phone:773-717-3370
Mailing Address - Fax:
Practice Address - Street 1:5050 N SHERIDAN RD APT 312
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-3181
Practice Address - Country:US
Practice Address - Phone:773-717-3370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-20
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter