MEDICARE: MARY MURRAY PA-C

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	363A00000X	Physician Assistant	085000331	IL

General Provider Information

NPI Number	:	1730102468
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY MURRAY PA-C

Provider Business Mailing Address
First Line	:	201 E HURON ST
Second Line	:	FLOOR 5, SUITE 110
City	:	CHICAGO
State	:	IL
Zip	:	60611-3197
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3207 LAKE AVE
Second Line	:
City	:	WILMETTE
State	:	IL
Zip	:	60091-1082
Country	:	US
Telephone Number	:	847-873-8000
Fax Number	:

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

Provider Enumeration Date	:	07/25/2006
Last Update Date	:	03/03/2026

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