Healthcare Provider Details

I. General information

NPI: 1770365405
Provider Name (Legal Business Name): MICHAEL MCKAY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2023
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5342 W ELM ST
MCHENRY IL
60050-4029
US

IV. Provider business mailing address

5342 W ELM ST
MCHENRY IL
60050-4029
US

V. Phone/Fax

Practice location:
  • Phone: 847-931-2341
  • Fax:
Mailing address:
  • Phone: 847-931-2341
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number150.119011
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: