Basic Information
| Provider Information | |||||||||
| NPI: | 1639534381 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KORDAS | ||||||||
| FirstName: | MARIA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1212 E ALGONQUIN RD | ||||||||
| Address2: | |||||||||
| City: | ALGONQUIN | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601025446 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6302320280 | ||||||||
| FaxNumber: | 6302323895 | ||||||||
| Practice Location | |||||||||
| Address1: | 1212 E ALGONQUIN RD | ||||||||
| Address2: | |||||||||
| City: | ALGONQUIN | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601025446 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2247130003 | ||||||||
| FaxNumber: | 2246787122 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/23/2015 | ||||||||
| LastUpdateDate: | 11/05/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/05/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LG0600X | 209012835 | IL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Gerontology |
ID Information
| ID | Type | State | Issuer | Description | F400268410 | 01 | IL | MEDICARE PTAN (INDIVIDUAL) | OTHER | 206147 | 01 | IL | MEDICARE PTAN (GROUP) | OTHER |