Provider Demographics
NPI:1720012446
Name:MAHONEY, EILEEN M (MD)
Entity Type:Individual
Prefix:DR
First Name:EILEEN
Middle Name:M
Last Name:MAHONEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 SALT CREEK LN STE 101
Mailing Address - Street 2:
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-3032
Mailing Address - Country:US
Mailing Address - Phone:630-789-3110
Mailing Address - Fax:630-241-0884
Practice Address - Street 1:11 SALT CREEK LN STE 101
Practice Address - Street 2:
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-3032
Practice Address - Country:US
Practice Address - Phone:630-789-3110
Practice Address - Fax:630-241-0884
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036090704207Y00000X, 207YP0228X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YP0228XAllopathic & Osteopathic PhysiciansOtolaryngologyPediatric Otolaryngology
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL399980OtherGROUP MEDICARE PTAN
399980OtherGROUP PTAN
ILG70013Medicare UPIN
399980OtherGROUP PTAN
IL040013396Medicare ID - Type UnspecifiedRAILROAD MEDICARE
IL446170Medicare ID - Type UnspecifiedMEDICARE LOCATION 15
399980OtherGROUP PTAN
IL040013396Medicare ID - Type UnspecifiedRAILROAD MEDICARE
IL446180Medicare ID - Type UnspecifiedMEDICARE LOCATION 16
IL036090704Medicaid