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NPI Code Detail

MEDICARE: DR. JOAN MARIE MCELLIGOTT D.O.

MEDICARE: DR. JOAN MARIE MCELLIGOTT D.O.
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
1207Q00000XFamily Medicine PhysicianIL

General Provider Information

NPI Number : 1831164896
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JOAN MARIE MCELLIGOTT D.O.
Provider Business Mailing Address
First Line : 7530 W COLLEGE DR
Second Line : SUITE B
City : PALOS HEIGHTS
State : IL
Zip : 60463-1196
Country : US
Telephone Number : 708-361-6714
Fax Number : 708-361-9514
Provider Business Practice Location Address
First Line : 7530 W COLLEGE DR
Second Line :
City : PALOS HEIGHTS
State : IL
Zip : 60463-1196
Country : US
Telephone Number : 708-361-6714
Fax Number : 708-361-9514
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/22/2006
Last Update Date : 07/08/2007

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