Healthcare Provider Details

I. General information

NPI: 1427503168
Provider Name (Legal Business Name): COLLEEN MCGUIRE MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2016
Last Update Date: 08/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 REVERE DR
NORTHBROOK IL
60062-1563
US

IV. Provider business mailing address

60 REVERE DR
NORTHBROOK IL
60062-1563
US

V. Phone/Fax

Practice location:
  • Phone: 224-306-1879
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number036133815
License Number StateIL

VIII. Authorized Official

Name: COLLEEN MCGUIRE
Title or Position: OWNER / PRESIDENT
Credential: MD
Phone: 224-306-1879