Healthcare Provider Details

I. General information

NPI: 1770070013
Provider Name (Legal Business Name): MARY MURAD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2018
Last Update Date: 06/16/2022
Certification Date: 06/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6303 N CLARK ST
CHICAGO IL
60660-1203
US

IV. Provider business mailing address

401 N MICHIGAN AVE STE 1200
CHICAGO IL
60611-4264
US

V. Phone/Fax

Practice location:
  • Phone: 773-270-1652
  • Fax:
Mailing address:
  • Phone: 844-559-1600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209017307
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: