Provider Demographics
NPI:1437101615
Name:MCGRAW, MARTHA T (MD)
Entity Type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:T
Last Name:MCGRAW
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MARTHA
Other - Middle Name:E
Other - Last Name:TRIESCHMANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:25 N WINFIELD ROAD
Mailing Address - Street 2:SUITE 500
Mailing Address - City:WINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60190-1295
Mailing Address - Country:US
Mailing Address - Phone:630-933-4056
Mailing Address - Fax:630-933-4057
Practice Address - Street 1:25 N WINFIELD ROAD
Practice Address - Street 2:SUITE 500
Practice Address - City:WINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60190-1295
Practice Address - Country:US
Practice Address - Phone:630-933-4056
Practice Address - Fax:630-933-4057
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2013-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL3360832412084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL206147OtherMEDICARE PTAN (GROUP)
IL336083241Medicaid
CA4748OtherMEDICARE RAILROAD PTAN (GROUP)
IL206147032OtherMEDICARE PTAN (INDIVIDUAL)
IL036121731Medicaid
P00884745OtherMEDICARE RAILROAD PTAN (INDIVIDUAL)
IL336083241Medicaid
GAH85447Medicare UPIN
IL206147032OtherMEDICARE PTAN (INDIVIDUAL)
GA13BDDQTMedicare ID - Type Unspecified