Provider Demographics
NPI:1164770616
Name:MAYCLARE III PC
Entity Type:Organization
Organization Name:MAYCLARE III PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:P
Authorized Official - Last Name:HONAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:309-353-0825
Mailing Address - Street 1:600 S 13TH ST
Mailing Address - Street 2:SUITE E
Mailing Address - City:PEKIN
Mailing Address - State:IL
Mailing Address - Zip Code:61554-4936
Mailing Address - Country:US
Mailing Address - Phone:309-353-0473
Mailing Address - Fax:309-347-3148
Practice Address - Street 1:600 S 13TH ST
Practice Address - Street 2:SUITE E
Practice Address - City:PEKIN
Practice Address - State:IL
Practice Address - Zip Code:61554-4936
Practice Address - Country:US
Practice Address - Phone:309-353-0473
Practice Address - Fax:309-347-3148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-15
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360868003207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty