Healthcare Provider Details

I. General information

NPI: 1710882766
Provider Name (Legal Business Name): MCLEAN MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2026
Last Update Date: 10/10/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

995 MAIN ST
ANTIOCH IL
60002-1535
US

IV. Provider business mailing address

995 MAIN ST
ANTIOCH IL
60002-1535
US

V. Phone/Fax

Practice location:
  • Phone: 224-224-7722
  • Fax:
Mailing address:
  • Phone: 224-224-7722
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: ANN M ROBLES
Title or Position: OFFICER
Credential: FNP-BC
Phone: 224-800-4087