Provider Demographics
NPI:1174678684
Name:MCGINNIS, PATRICK L (MD)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:L
Last Name:MCGINNIS
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 1:2614 W JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-6433
Mailing Address - Country:US
Mailing Address - Phone:815-725-1355
Mailing Address - Fax:815-725-9857
Practice Address - Street 1:3235 VOLLMER RD
Practice Address - Street 2:SUITE 120
Practice Address - City:FLOSSMOOR
Practice Address - State:IL
Practice Address - Zip Code:60422-2013
Practice Address - Country:US
Practice Address - Phone:708-957-3454
Practice Address - Fax:708-957-3495
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2012-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036053460207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036053460Medicaid
IL208256002OtherMEDICARE INDIV ID# FOR GROUP 208256
ILP00791994 GRP-C31261OtherMEDICARE RR
IL205474002OtherMEDICARE INDIV ID# FOR GROUP 205474
IL336140002OtherMEDICARE INDIV ID# FOR GROUP 336140
ILP00791994OtherMEDICARE RR
IL208256002OtherMEDICARE INDIV ID# FOR GROUP 208256
IL336140002OtherMEDICARE INDIV ID# FOR GROUP 336140
C44249Medicare UPIN
ILK47116Medicare PIN
IL336140002Medicare PIN
IL336140Medicare PIN