Provider Demographics
NPI:1174563811
Name:MCGRATH, KRIS G (MD)
Entity type:Individual
Prefix:DR
First Name:KRIS
Middle Name:G
Last Name:MCGRATH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:500 N MICHIGAN AVE
Mailing Address - Street 2:SUITE 1640
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-3777
Mailing Address - Country:US
Mailing Address - Phone:312-222-9500
Mailing Address - Fax:312-222-9589
Practice Address - Street 1:500 N MICHIGAN AVE
Practice Address - Street 2:SUITE 1640
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-3777
Practice Address - Country:US
Practice Address - Phone:312-222-9500
Practice Address - Fax:312-222-9589
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2010-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36-3304645174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036-060890Medicaid
ILE59646Medicare UPIN
IL036-060890Medicaid