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General NPI Number Information
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NPI Number | 1851412779
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Entity Type | Individual
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Provider Name | KRISTOPHER MICHAEL MCDONOUGH M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/02/2007
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Last Update Date | 11/30/2009
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Provider Practice Location Address
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Address Line | 903 N 129TH INFANTRY DR SUITE #400
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City | JOLIET
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State | IL
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Zip | 60435-3171
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Country | US
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Telephone | 815-725-2653
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Fax | 815-744-3232
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Provider Business Mailing Address
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Address Line | 903 N 129TH INFANTRY DR SUITE #400
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City | JOLIET
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State | IL
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Zip | 60435-3171
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Country | US
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Telephone | 815-725-2653
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Fax | 815-744-3232
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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 | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | 36113500
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License Number State | IL
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