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Mae Pedroso Provo
NPI 1225210073 · on the registry since 2007 · sole proprietor
Practice
- Address
- 6711 Pine Lake Dr
Tinley Park, IL 60477 - Phone
- (630) 272-1788
- Fax
- (630) 679-0038
Registry record
- Primary taxonomy
- 225100000X
225100000X
- Licence states on file
- IL
From the registry's licence fields, which are often incomplete.
- Sex
- Female
- Record last updated
- 2007-12-04
Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Illinois