MEDICARE: DR. MARY E. DORAN D.P.M

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
1	213E00000X	Podiatrist	016005093	IL

Other Identifiers

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

General Provider Information

NPI Number	:	1619976016
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARY E. DORAN D.P.M

Provider Business Mailing Address
First Line	:	227 CLUBHOUSE ST
Second Line	:
City	:	BOLINGBROOK
State	:	IL
Zip	:	60490-2058
Country	:	US
Telephone Number	:	630-739-6610
Fax Number	:

Provider Business Practice Location Address
First Line	:	726 S WEBER RD
Second Line	:
City	:	BOLINGBROOK
State	:	IL
Zip	:	60490-5451
Country	:	US
Telephone Number	:	630-739-6610
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/18/2005
Last Update Date	:	08/27/2025

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