Healthcare Provider Details

I. General information

NPI: 1295883791
Provider Name (Legal Business Name): THERESA MARIE MCCARTHY D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 04/27/2021
Certification Date: 04/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15900 SOUTH CICERO AVE
OAK FOREST IL
60452
US

IV. Provider business mailing address

15900 SOUTH CICERO AVE
OAK FOREST IL
60452
US

V. Phone/Fax

Practice location:
  • Phone: 708-633-3091
  • Fax: 708-633-2006
Mailing address:
  • Phone: 708-633-3091
  • Fax: 708-633-2006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204R00000X
TaxonomyElectrodiagnostic Medicine Physician
License Number036-088685
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code2081P0004X
TaxonomySpinal Cord Injury Medicine Physician
License Number036-088685
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number036-088685
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: