Provider Demographics
NPI:1023025541
Name:MCCRAY, GARY MYLES (MD)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:MYLES
Last Name:MCCRAY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1530 ALIMA TER
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60526-1331
Mailing Address - Country:US
Mailing Address - Phone:708-783-5572
Mailing Address - Fax:708-482-4093
Practice Address - Street 1:1530 ALIMA TER
Practice Address - Street 2:
Practice Address - City:LA GRANGE PARK
Practice Address - State:IL
Practice Address - Zip Code:60526-1331
Practice Address - Country:US
Practice Address - Phone:708-783-5572
Practice Address - Fax:708-482-4093
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2008-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036064789207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036064789Medicaid
IL211553Medicare ID - Type UnspecifiedONE LOCALITY
ILC37113Medicare UPIN
IL211557Medicare ID - Type UnspecifiedSECOND LOCALITY