Individual ProviderMahveen EthezazFamily MedicineAllopathic & Osteopathic PhysiciansPractice Address908 N Elm St Ste 103, Hinsdale, IL 60521-3635(630) 789-8890(630) 469-9200PECOS EnrollmentBased on the most recent information from CMS, provider Mahveen Ethezaz is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records yesterday at 12:57 PM.Profile DetailsProvider ID1699193268Provider TypeIndividualFull NameEthezaz, MahveenCredentialM.D.GenderFemaleSole ProprietorNoEnumeration Date4/1/2014Last Updated8/29/2023Contact InformationPractice LocationPractice Address908 N Elm St Ste 103, Hinsdale, IL 60521-3635Phone(630) 789-8890Fax(630) 789-8892Mailing LocationMailing AddressPO Box 713260, Chicago, IL 60677-1260Phone(630) 469-9200FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode207Q00000XPrimaryDescriptionFamily MedicineAllopathic & Osteopathic PhysiciansLicense036-151954IllinoisCode207Q00000XDescriptionFamily MedicineAllopathic & Osteopathic PhysiciansLicense61445MinnesotaProvider IdentifiersIDDescriptionIssuerID036151954DescriptionMedicaidIssuerUnlistedIllinois