Provider Demographics
NPI:1619437738
Name:DEMENT, MARY CATHERINE (DO)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:CATHERINE
Last Name:DEMENT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7900 N MILWAUKEE AVE STE 19
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:IL
Mailing Address - Zip Code:60714-3239
Mailing Address - Country:US
Mailing Address - Phone:847-318-9595
Mailing Address - Fax:
Practice Address - Street 1:7900 N MILWAUKEE AVE STE 19
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:IL
Practice Address - Zip Code:60714-3239
Practice Address - Country:US
Practice Address - Phone:847-318-9595
Practice Address - Fax:847-318-9599
Is Sole Proprietor?:No
Enumeration Date:2019-03-24
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.157934207RG0100X
IL125.073863207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine