Gannon, Mary L.

Gannon, Mary L. is an sole proprietor health care provider with primary practice located at 2625 Butterfield Rd Suite 103 W, Oak Brook IL 60523-1234. She recently has only one registered license in Allopathic & Osteopathic Physicians / Addiction Medicine, which is considered as her primary health care specialty. Gannon, Mary L. can be contacted via phone (630) 981-4886.

Contact Information

Primary practice address
2625 Butterfield Rd Suite 103 W Oak Brook IL 60523-1234
Phone: (630) 981-4886
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Addiction Medicine 2084A0401X 036068239 Illinois

Profile Details

NPI number 1235268541
LBN Legal business name Gannon, Mary L.
Credentials M.D.,C.A.D.C.
Entity Individual
Sole proprietor 1 Yes
Enumeration date Mar 4th, 2007
Last updated May 17th, 2011 - about 14 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1235268541 NPPES
Kentucky Other 234667000 MAGELLAN BEHAVIORAL HEALT
Kentucky Other 133348420017 MAGELLAN BEHAVIORAL HEALT
Kentucky Other GANNMARY MAGELLAN BEHAVIORAL HEALT

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