MEDICARE: DR. SANDRA RENEE MCGOWAN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	036-112129	IL

General Provider Information

NPI Number	:	1568481232
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SANDRA RENEE MCGOWAN M.D.

Provider Business Mailing Address
First Line	:	222 VOLLMER RD STE 2A
Second Line	:
City	:	CHICAGO HEIGHTS
State	:	IL
Zip	:	60411-1892
Country	:	US
Telephone Number	:	708-480-9730
Fax Number	:	877-522-7815

Provider Business Practice Location Address
First Line	:	222 VOLLMER RD STE 2A
Second Line	:
City	:	CHICAGO HEIGHTS
State	:	IL
Zip	:	60411-1892
Country	:	US
Telephone Number	:	708-480-9730
Fax Number	:	877-522-7815

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/19/2006
Last Update Date	:	11/07/2025

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