Healthcare Provider Details

I. General information

NPI: 1083097000
Provider Name (Legal Business Name): PILAR MCKAY RAINEY D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2015
Last Update Date: 07/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 NE GLEN OAK
PEORIA IL
61634-0001
US

IV. Provider business mailing address

642 N COOLIDGE CT
WEST PEORIA IL
61604-4809
US

V. Phone/Fax

Practice location:
  • Phone: 309-655-4163
  • Fax:
Mailing address:
  • Phone: 713-851-6795
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number125.067340
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: