Individual
MARY EILEEN MCCORMACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
800 W BURRELL DR, CROWN POINT, IN 46307-8898
(219) 663-9913
(219) 663-9923
Mailing address
PO BOX 781076, DETROIT, MI 48278-1076
(317) 528-4800
(317) 865-1479
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
02001585A
IN
208M00000X
Hospitalist Physician
02001585A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000088456
ANTHEM BC/BS
IN
01
—
160057113
RAIL ROAD MEDICARE
IN
05
—
200017580A
—
IN
01
—
M47140040
MEDICARE
IN
Enumeration date
08/16/2006
Last updated
03/07/2025
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