Provider Demographics
NPI:1245240662
Name:MCDONIEL, CATHERINE ANN (DO)
Entity Type:Individual
Prefix:DR
First Name:CATHERINE
Middle Name:ANN
Last Name:MCDONIEL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:CATHERINE
Other - Middle Name:ANN
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:1890 SILVER CROSS BLVD
Mailing Address - Street 2:STE 570
Mailing Address - City:NEW LENOX
Mailing Address - State:IL
Mailing Address - Zip Code:60451-9606
Mailing Address - Country:US
Mailing Address - Phone:708-226-2623
Mailing Address - Fax:
Practice Address - Street 1:15300 WEST AVE
Practice Address - Street 2:STE 22
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-4600
Practice Address - Country:US
Practice Address - Phone:708-226-2623
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2018-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A8834207Q00000X
IL036123113207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00AX88340Medicaid
CA00AX88340Medicaid
CAW20A8834AMedicare ID - Type Unspecified