Healthcare Provider Details

I. General information

NPI: 1710947148
Provider Name (Legal Business Name): ROSEMARY MCGRATH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2006
Last Update Date: 01/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11243 LA PORTE RD
MOKENA IL
60448-1374
US

IV. Provider business mailing address

1860 PAYSHERE CIR
CHICAGO IL
60674-1374
US

V. Phone/Fax

Practice location:
  • Phone: 708-479-4681
  • Fax: 708-479-8516
Mailing address:
  • Phone: 630-469-9200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036077425
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: