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Individual
DR. MARY MICHAEL WESTERHOLM
Active
Individual
DR. MARY MICHAEL WESTERHOLM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
036116854
IL
208000000X
Pediatrics Physician
036116854
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0222075
BLUE CROSS GROUP NUMBER
IL
05
—
036116854
—
IL
01
—
363149833
TAX IDENTIFICATION NUMBER
IL
01
—
3631498336019001
CDPG HFS PAYEE ID
IL
01
—
487450
MEDICARE GROUP NUMBER
IL
01
—
P00659358
MEDICARE RAILROAD
IL
Enumeration date
05/06/2008
Last updated
04/15/2013
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