Healthcare Provider Details

I. General information

NPI: 1639376551
Provider Name (Legal Business Name): MARYKATHLEEN A. HENEGHAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARYKATHLEEN A. SADOWSKI M.D.

II. Dates (important events)

Enumeration Date: 07/03/2007
Last Update Date: 06/27/2022
Certification Date: 06/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1675 DEMPSTER ST 2ND FLOOR
PARK RIDGE IL
60068-1110
US

IV. Provider business mailing address

29373 NETWORK PL
CHICAGO IL
60673-1110
US

V. Phone/Fax

Practice location:
  • Phone: 847-723-9300
  • Fax:
Mailing address:
  • Phone: 847-390-5900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number50592
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number036-116599
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: