Basic Information
| Provider Information | |||||||||
| NPI: | 1659626554 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MAUZO | ||||||||
| FirstName: | SHAKUNTALA | ||||||||
| MiddleName: | HANUMANT | ||||||||
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| Credential: | MBBS,MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 5995 | ||||||||
| Address2: | |||||||||
| City: | CAROL STREAM | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601975995 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7135005302 | ||||||||
| FaxNumber: | 7135000712 | ||||||||
| Practice Location | |||||||||
| Address1: | 701 N. FIRST ST | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | IL | ||||||||
| PostalCode: | 627810002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2177883000 | ||||||||
| FaxNumber: | 2177885577 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/17/2012 | ||||||||
| LastUpdateDate: | 06/13/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZP0101X | 036.145741 | IL | Y | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology |
No ID Information.