Individual
MICHAEL J MCDERMOTT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
14532 JOHN HUMPHREY DR, ORLAND PARK, IL 60462-2640
(708) 403-1611
(708) 403-1650
Mailing address
14532 JOHN HUMPHREY DR, ORLAND PARK, IL 60462
(708) 403-1611
(708) 403-1650
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
016004034
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
016004034
—
IL
01
—
363863248
MEDICARE
IL
01
—
60101286
BLUE CROSS
—
01
—
IL4307
MEDICARE PTAN
IL
Enumeration date
05/10/2006
Last updated
12/15/2021
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