DR. JELICA MAZE


Address: 3800 W 203rd St Ste 204, Olympia Fields, IL 60461-1185
Phone: 7086792380

DR. JELICA MAZE (NPI# 1811162704) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1811162704
Entity Type Individual
Full Name DR. JELICA MAZE
Other Name DR. JELICA JANICIJEVIC
Credential M.D.
Practice Address 3800 W 203rd St Ste 204
Olympia Fields
IL 60461-1185
Mailing Address Po Box 781076
Detroit
MI 48278-1076
Practice Telephone 7086792380
Mailing Telephone 3175284800
Enumeration Date 2008-04-23
Last Update Date 2020-04-10
Gender Code F
Is Sole Proprietor N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 207RC0000X Internal Medicine
Specialization: Cardiovascular Disease
01077479A IN Allopathic & Osteopathic Physicians
N 207RC0000X Internal Medicine
Specialization: Cardiovascular Disease
036132452 IL Allopathic & Osteopathic Physicians
N 207RC0000X Internal Medicine
Specialization: Cardiovascular Disease
ME112860 FL Allopathic & Osteopathic Physicians
N 207RC0000X Internal Medicine
Specialization: Cardiovascular Disease
MD445339 PA Allopathic & Osteopathic Physicians

Other Provider Identifier

State Issuer Identifier Type Code
IL 036132452 05
IL BCBS GROUP 1124399605 01

Provider Secondary Practice Location

Address Telephone Number Fax Number
1205 S Main St Ste 101, Crown Point, IN 463073677 2196620077

Office Location

Street Address 3800 W 203RD ST STE 204
City OLYMPIA FIELDS
State IL
Zip Code 60461-1185

Providers in the same location

NPI Name Taxonomy Address Enumeration
1043203862 Matthew L Kamin Internal Medicine 3800 W 203rd St Ste 204, Olympia Fields, IL 60461-1185 2005-08-26
1154724912 Anna C. Davies Nurse Practitioner 3800 W 203rd St Ste 204, Olympia Fields, IL 60461 2014-10-07
1053553313 Brie-ann Alexandra Muller Pediatrics 3800 W 203rd St Ste 204, Olympia Fields, IL 60461 2009-04-01
1255370136 Mohamad Martini Internal Medicine 3800 W 203rd St Ste 204, Olympia Fields, IL 60461 2006-06-06
1821052416 Tahir M Khokher Internal Medicine 3800 W 203rd St Ste 204, Olympia Fields, IL 60461-1185 2006-04-12

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1609372564 Katherine Gill Haddad Student in an Organized Health Care Education/Training Program 20201 S. Crawford Avenue, Attn: Postdoctoral Education, Olympia Fields, IL 60461 2018-03-31
1750886610 Kim Minh Dang Student in an Organized Health Care Education/Training Program 20201 South Crawford, Olympia Fields, IL 60461 2018-03-23
1619484110 Alexandra N. Douvas Dentist 20180 Governors Hwy, Ste 104, Olympia Fields, IL 60461 2018-01-05
1992258438 Krystyne Doty Nurse Practitioner 3800 W 203rd St Ste 209, Olympia Fields, IL 60461 2016-08-02
1205286747 Shirlene Umali Registered Nurse 20201 South Crawford Ave, Olympia Fields, IL 60461 2016-06-15
1386002590 Touch of Wholeness Psychological Services, LLC Psychologist 20280 Governors Dr, Suite 207, Olympia Fields, IL 60461 2016-02-02
1063895357 David Dardick Dentist 20180 Governors Hwy Ste 104, Olympia Fields, IL 60461 2015-07-04
1811378623 Fins Healthcare Agency Nursing Care 3612 Lincohn Highway, Suite 19, Olympia Fields, IL 60461 2015-06-17
1285048959 Garud Ranga Raj Orthopaedic Surgery 20817 Alexander St, Olympia Fields, IL 60461 2014-06-20
1811316334 Brett Hapeman Emergency Medicine 20201 S Crawford, Attn: Postdoctoral Education, Olympia Fields, IL 60461 2014-04-11
Find all providers in zip 60461

Taxonomy Information

Taxonomy Code 207RC0000X
Grouping Allopathic & Osteopathic Physicians
Classification Internal Medicine
Specialization Cardiovascular Disease

Taxonomy Definition

An internist who specializes in diseases of the heart and blood vessels and manages complex cardiac conditions such as heart attacks and life-threatening, abnormal heartbeat rhythms.
Notes: Source: American Osteopathic Board of Internal Medicine, 2008 [7/1/2008: added definition, added source; 7/1/2011: modified source]
- Additional Resources: American Board of Internal Medicine, http://www.abim.org/. American Osteopathic Board of Internal Medicine, https://www.osteopathic.org/certification
- Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine.

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1124399605 South Suburban Cardiology Associates, Ltd. Internal Medicine 20303 S Crawford Ave, Suite 120, Olympia Fields, IL 60461-1176 2012-01-16
1043203862 Matthew L Kamin Internal Medicine 3800 W 203rd St Ste 204, Olympia Fields, IL 60461-1185 2005-08-26
1982609723 Narayan Mulamalla Internal Medicine 3800 203rd St, Ste 209, Olympia Fields, IL 60461-1939 2005-06-17
1932342102 Mohammad Shakir Internal Medicine 20201 Crawford Ave, Olympia Fields, IL 60461-1010 2009-04-16
1972640654 Midwest Physician Group Ltd Internal Medicine 3800 W 203rd St, Suite 202, Olympia Fields, IL 60461-1184 2007-01-31
1043329394 Cardiovascular Care Associates S.c. Internal Medicine 3800 203rd St, Suite 209, Olympia Fields, IL 60461-1936 2006-08-30
1417967829 Lawrence U Haspel Internal Medicine 3800 W 203rd St, Ste 202, Olympia Fields, IL 60461-1184 2006-08-08
1255370136 Mohamad Martini Internal Medicine 3800 W 203rd St Ste 204, Olympia Fields, IL 60461 2006-06-06
1083668560 Noel Camba Internal Medicine 3800 W 203rd St, Suite 204, Olympia Fields, IL 60461-1184 2006-05-20
1407812050 Hassan Kieso Internal Medicine 3800 W 203rd St, Suite 204, Olympia Fields, IL 60461-1184 2006-04-24
Find all providers in OLYMPIA FIELDS

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City OLYMPIA FIELDS
Zip Code 60461

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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