Healthcare Provider Details

I. General information

NPI: 1831341908
Provider Name (Legal Business Name): MICHAEL J. MCGRAIL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/21/2008
Last Update Date: 06/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3860 W 95TH ST SUITE 6
EVERGREEN PARK IL
60805-2034
US

IV. Provider business mailing address

3860 W 95TH ST SUITE 6
EVERGREEN PARK IL
60805-2034
US

V. Phone/Fax

Practice location:
  • Phone: 708-425-3900
  • Fax: 708-425-3939
Mailing address:
  • Phone: 708-425-3900
  • Fax: 708-425-3939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number336082703
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: