Healthcare Provider Details

I. General information

NPI: 1003374141
Provider Name (Legal Business Name): ALLISON BYRNE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALLISON DONOVAN

II. Dates (important events)

Enumeration Date: 03/07/2019
Last Update Date: 02/18/2025
Certification Date: 02/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 LAKE ST STE 301
OAK PARK IL
60301-1133
US

IV. Provider business mailing address

1010 LAKE ST STE 301
OAK PARK IL
60301-1133
US

V. Phone/Fax

Practice location:
  • Phone: 708-524-8600
  • Fax:
Mailing address:
  • Phone: 708-524-8600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036160413
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: