Healthcare Provider Details

I. General information

NPI: 1730102468
Provider Name (Legal Business Name): MARY MURRAY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 12/06/2025
Certification Date: 12/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3207 LAKE AVE
WILMETTE IL
60091-1082
US

IV. Provider business mailing address

201 E HURON ST FLOOR 5, SUITE 110
CHICAGO IL
60611-3197
US

V. Phone/Fax

Practice location:
  • Phone: 847-873-8000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085000331
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number1689434987
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: