Provider Demographics
NPI:1376539718
Name:MCLAIN, MONIKA (MD)
Entity Type:Individual
Prefix:DR
First Name:MONIKA
Middle Name:
Last Name:MCLAIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 HOLLISTER DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-5263
Mailing Address - Country:US
Mailing Address - Phone:847-680-3666
Mailing Address - Fax:847-680-3994
Practice Address - Street 1:1800 HOLLISTER DR
Practice Address - Street 2:SUITE 102
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-5263
Practice Address - Country:US
Practice Address - Phone:847-680-3666
Practice Address - Fax:847-680-3994
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2011-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36082866207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF-04808Medicare UPIN