Healthcare Provider Details

I. General information

NPI: 1679100226
Provider Name (Legal Business Name): MEGAN NICOLE CLEARY DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2020
Last Update Date: 10/08/2025
Certification Date: 10/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

836 W WELLINGTON AVE
CHICAGO IL
60657-5147
US

IV. Provider business mailing address

836 W WELLINGTON AVE
CHICAGO IL
60657-5147
US

V. Phone/Fax

Practice location:
  • Phone: 774-975-1600
  • Fax:
Mailing address:
  • Phone: 774-975-1600
  • Fax: 913-588-6414

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number036170945
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: