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NPI Code Detail

MEDICARE: MR. DENNIS E MCCREARY

MEDICARE: MR. DENNIS E MCCREARY
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician036058406IL
2207Q00000XFamily Medicine Physician54510WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1396720694
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. DENNIS E MCCREARY
Provider Business Mailing Address
First Line : PO BOX 735044
Second Line :
City : CHICAGO
State : IL
Zip : 60673-5044
Country : US
Telephone Number : 800-326-2250
Fax Number :
Provider Business Practice Location Address
First Line : 3115 LEWIS AVE
Second Line :
City : ZION
State : IL
Zip : 60099-3099
Country : US
Telephone Number : 847-746-3752
Fax Number : 847-746-9144
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/08/2005
Last Update Date : 06/04/2024

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