Healthcare Provider Details

I. General information

NPI: 1841202421
Provider Name (Legal Business Name): TIMOTHY RUSSELL MCCURRY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 02/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 BISHOP CT
MT PROSPECT IL
60056-6039
US

IV. Provider business mailing address

1550 BISHOP CT
MT PROSPECT IL
60056-6039
US

V. Phone/Fax

Practice location:
  • Phone: 847-685-9900
  • Fax:
Mailing address:
  • Phone: 847-685-9900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036-071081
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number036-071081
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number036-071081
License Number StateIL
# 4
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number036-071081
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: