Provider Demographics
NPI:1376071795
Name:DWYER, MEAGHAN LEIGH (MD)
Entity Type:Individual
Prefix:
First Name:MEAGHAN
Middle Name:LEIGH
Last Name:DWYER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:250 E SUPERIOR ST STE 4-2304
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2914
Mailing Address - Country:US
Mailing Address - Phone:312-926-5522
Mailing Address - Fax:312-695-5645
Practice Address - Street 1:250 E SUPERIOR ST STE 4-2304
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2914
Practice Address - Country:US
Practice Address - Phone:312-926-5522
Practice Address - Fax:312-695-5645
Is Sole Proprietor?:No
Enumeration Date:2017-05-30
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0361610942085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology