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General NPI Number Information
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NPI Number | 1699734186
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Entity Type | Individual
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Provider Name | DESMOND B MCDONAGH MD
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Gender | Male
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Dates
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Enumeration Date | 03/22/2006
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Last Update Date | 05/20/2008
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Provider Practice Location Address
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Address Line | 1790 NATIONS DR SUITE #207
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City | GURNEE
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State | IL
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Zip | 60031-9164
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Country | US
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Telephone | 847-205-9900
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Fax | 847-205-9905
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Provider Business Mailing Address
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Address Line | 1901 BUTTERFIELD RD STE 220
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City | DOWNERS GROVE
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State | IL
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Zip | 60515-7915
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Country | US
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Telephone | 630-725-2768
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Fax | 630-725-2783
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | 036046231
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 202K00000X
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Taxonomy Name | Phlebology Physician
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License Number | 036-046231
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License Number State | IL
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