Provider Demographics
NPI:1659442432
Name:MAYCLARE II LTD
Entity Type:Organization
Organization Name:MAYCLARE II LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:P
Authorized Official - Last Name:HONAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:309-347-9709
Mailing Address - Street 1:3223 GRIFFIN AVE
Mailing Address - Street 2:
Mailing Address - City:PEKIN
Mailing Address - State:IL
Mailing Address - Zip Code:61554-6214
Mailing Address - Country:US
Mailing Address - Phone:309-347-9709
Mailing Address - Fax:309-347-1719
Practice Address - Street 1:3223 GRIFFIN AVE
Practice Address - Street 2:
Practice Address - City:PEKIN
Practice Address - State:IL
Practice Address - Zip Code:61554
Practice Address - Country:US
Practice Address - Phone:309-347-9709
Practice Address - Fax:309-347-1719
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILDA4767OtherRAIL ROAD MEDICARE GROUP
IL209024Medicare ID - Type Unspecified
IL209024Medicare PIN