Individual
MICHAEL PATRICK PENDERGAST SR.
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
WESTERN ILLINOS UNIVERSITY ATHLETIC DEPT., ONE UNIV. CIRCLE, MACOMB, IL 61455
(309) 208-1253
Mailing address
340 W PIERCE ST, MACOMB, IL 61455-1443
(309) 833-5316
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
IL
Other
Enumeration date
04/20/2006
Last updated
07/08/2007
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