Individual
DR. MARY KATHLEEN LOCKARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
505 E GRANT ST, SUITE 103, MACOMB, IL 61455-3352
(309) 833-3536
(309) 836-5729
Mailing address
PO BOX 556, MACOMB, IL 61455-0556
(309) 833-3536
(309) 836-5729
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
036111319
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036111319
—
IL
Enumeration date
07/08/2005
Last updated
06/30/2011
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