Provider Demographics
NPI:1144215229
Name:MCGONAGLE, TIMOTHY K (MD,)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:K
Last Name:MCGONAGLE
Suffix:
Gender:M
Credentials:MD,
Other - Prefix:
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Mailing Address - Street 1:3340 OAK PARK AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BERWYN
Mailing Address - State:IL
Mailing Address - Zip Code:60402-3420
Mailing Address - Country:US
Mailing Address - Phone:708-783-0222
Mailing Address - Fax:708-783-0223
Practice Address - Street 1:3340 OAK PARK AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:BERWYN
Practice Address - State:IL
Practice Address - Zip Code:60402-3420
Practice Address - Country:US
Practice Address - Phone:708-783-0222
Practice Address - Fax:708-783-0223
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036-0838352084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036083835Medicaid
IL130024570OtherRR MEDICARE
IL130024570OtherRR MEDICARE
ILC52213Medicare UPIN