Individual
DR. MARY L. GANNON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.,C.A.D.C.
Contact information
Practice address
2625 BUTTERFIELD RD, SUITE 103 W, OAK BROOK, IL 60523-1234
(630) 981-4886
Mailing address
326 GRANDVIEW AVE, GLEN ELLYN, IL 60137-5220
(630) 981-4886
Taxonomy
Speciality
Code
Description
License number
State
2084A0401X
Addiction Medicine (Psychiatry & Neurology) Physician
Primary
036068239
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
133348420017
HUMANA
KY
01
—
234667000
MAGELLAN BEHAVIORAL HEALT
KY
01
—
GANNMARY
CORPHEALTH
KY
Enumeration date
03/04/2007
Last updated
05/17/2011
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