Healthcare Provider Details

I. General information

NPI: 1003058736
Provider Name (Legal Business Name): ANGELA C MCCORMICK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2009
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 MICHAEL JOHN DR
PARK RIDGE IL
60068-2675
US

IV. Provider business mailing address

2650 RIDGE AVE STE 1223
EVANSTON IL
60201-1700
US

V. Phone/Fax

Practice location:
  • Phone: 724-689-8278
  • Fax:
Mailing address:
  • Phone: 847-570-2040
  • Fax: 847-570-5315

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number036126779
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: