Provider Demographics
NPI:1710996103
Name:MAHONEY, ABIGAIL ALAYNE (DPM)
Entity Type:Individual
Prefix:DR
First Name:ABIGAIL
Middle Name:ALAYNE
Last Name:MAHONEY
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5401 N KNOXVILLE AVE
Mailing Address - Street 2:STE 117
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61614-5068
Mailing Address - Country:US
Mailing Address - Phone:309-689-8888
Mailing Address - Fax:
Practice Address - Street 1:5017 N GLEN PARK PLACE RD
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614-4677
Practice Address - Country:US
Practice Address - Phone:309-691-1589
Practice Address - Fax:309-692-2032
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2016-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016005175213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL016005175Medicaid
IDK32173Medicare ID - Type Unspecified
ILVO3839Medicare UPIN
ILK32172Medicare UPIN
IL016005175Medicaid
IL732422Medicare ID - Type Unspecified