Healthcare Provider Details

I. General information

NPI: 1447210877
Provider Name (Legal Business Name): MARY C. COLLINS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2006
Last Update Date: 12/03/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 SOUTH 5TH AVENUE EDWARD HINES, JR. VA HOSPITAL
HINES IL
60141
US

IV. Provider business mailing address

5000 SOUTH 5TH AVENUE EDWARD HINES, JR. VA HOSPITAL
HINES IL
60141
US

V. Phone/Fax

Practice location:
  • Phone: 708-202-8387
  • Fax: 708-202-2024
Mailing address:
  • Phone: 708-202-2838
  • Fax: 708-202-2024

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: