Provider Demographics
NPI:1235110784
Name:GAWRONSKI, MARY J (DO)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:J
Last Name:GAWRONSKI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:MISS
Other - First Name:MARY
Other - Middle Name:J
Other - Last Name:CHARRON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:29373 NETWORK PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-1700
Mailing Address - Country:US
Mailing Address - Phone:847-390-5900
Mailing Address - Fax:
Practice Address - Street 1:5057 SHORELINE RD
Practice Address - Street 2:
Practice Address - City:LAKE BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-1700
Practice Address - Country:US
Practice Address - Phone:847-381-5005
Practice Address - Fax:847-381-5036
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036 108348208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036 108348Medicaid