Provider Demographics
NPI:1164415808
Name:HUTTON, MARY C (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:C
Last Name:HUTTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:4201 WINFIELD RD FL 4
Mailing Address - Street 2:
Mailing Address - City:WARRENVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60555-4025
Mailing Address - Country:US
Mailing Address - Phone:331-221-6377
Mailing Address - Fax:331-221-2357
Practice Address - Street 1:1100 LAKE ST STE 230
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60301-1095
Practice Address - Country:US
Practice Address - Phone:331-221-9001
Practice Address - Fax:331-221-2759
Is Sole Proprietor?:No
Enumeration Date:2005-08-29
Last Update Date:2021-05-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036-077730207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036077730Medicaid
IL036077730Medicaid