Individual
MIKAELA LYNNE MCGRORY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
8200 W. ROOSEVELT ROAD, FOREST PARK, IL 60130-2528
(708) 488-9850
(708) 488-9870
Mailing address
401 N MICHIGAN AVE, SUITE 1200, CHICAGO, IL 60611-4264
(312) 635-0973
(813) 290-9691
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085004288
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
085004288
LICENSE NO
IL
Enumeration date
03/18/2012
Last updated
10/29/2015
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