Provider Demographics
NPI:1447210877
Name:COLLINS, MARY C (MD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:C
Last Name:COLLINS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:5000 SOUTH 5TH AVENUE
Mailing Address - Street 2:EDWARD HINES, JR. VA HOSPITAL
Mailing Address - City:HINES
Mailing Address - State:IL
Mailing Address - Zip Code:60141
Mailing Address - Country:US
Mailing Address - Phone:708-202-2838
Mailing Address - Fax:708-202-2024
Practice Address - Street 1:5000 SOUTH 5TH AVENUE
Practice Address - Street 2:EDWARD HINES, JR. VA HOSPITAL
Practice Address - City:HINES
Practice Address - State:IL
Practice Address - Zip Code:60141
Practice Address - Country:US
Practice Address - Phone:708-202-8387
Practice Address - Fax:708-202-2024
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILL74556Medicare UPIN
IL706750Medicare ID - Type Unspecified