Healthcare Provider Details

I. General information

NPI: 1639157142
Provider Name (Legal Business Name): MICHAEL EDWARD MCGARRY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3420 ILLINOIS ST USS TRANQUILLITY - BMC 1007
GREAT LAKES IL
60088-3120
US

IV. Provider business mailing address

3420 ILLINOIS ST USS TRANQUILLITY - BMC 1007
GREAT LAKES IL
60088-3120
US

V. Phone/Fax

Practice location:
  • Phone: 847-688-6755
  • Fax:
Mailing address:
  • Phone: 847-688-6755
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number036109704
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: