Healthcare Provider Details

I. General information

NPI: 1407888670
Provider Name (Legal Business Name): MARY REGINA HIGGINS MEDICAL DOCTOR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2551 COMPASS ROAD SUITE 100 GLENBROOK PEDIATRICS
GLENVIEW IL
60026
US

IV. Provider business mailing address

2551 COMPASS ROAD SUITE 100
GLENVIEW IL
60026
US

V. Phone/Fax

Practice location:
  • Phone: 847-729-6445
  • Fax: 847-729-9707
Mailing address:
  • Phone: 847-729-6445
  • Fax: 847-729-9707

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: