MEDICARE: DR. MAGGIE HEADLEY MD

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	207P00000X	Emergency Medicine Physician	36111776	IL

General Provider Information

NPI Number	:	1750592374
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MAGGIE HEADLEY MD

Provider Business Mailing Address
First Line	:	1926 W OHIO ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60622-5507
Country	:	US
Telephone Number	:	773-259-8781
Fax Number	:

Provider Business Practice Location Address
First Line	:	1926 W OHIO ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60622-5507
Country	:	US
Telephone Number	:	773-259-8781
Fax Number	:

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

Provider Enumeration Date	:	05/25/2007
Last Update Date	:	04/08/2014

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