Individual
MARY MULCAHEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2160 S 1ST AVE, MAYWOOD, IL 60153-3328
(708) 216-9000
Mailing address
1430 TULANE AVE, NEW ORLEANS, LA 70112-2632
(504) 988-5770
(504) 988-3597
Taxonomy
Speciality
Code
Description
License number
State
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
Primary
036163338
IL
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
304786
LA
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
MD449024
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
25MA09385600
NEW JERSEY MEDICAL LICENSE
NJ
01
—
304786
LOUISIANA MEDICAL LICENSE
LA
01
—
MD449024
PENNSYLVANIA MEDICAL LICENSE
PA
Enumeration date
04/20/2007
Last updated
04/24/2023
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