Provider Demographics
NPI:1720357981
Name:CLEARY, DOUGLAS G (MD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:G
Last Name:CLEARY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1283 FOREST GLEN DR S
Mailing Address - Street 2:
Mailing Address - City:WINNETKA
Mailing Address - State:IL
Mailing Address - Zip Code:60093-1427
Mailing Address - Country:US
Mailing Address - Phone:847-446-8790
Mailing Address - Fax:847-386-7058
Practice Address - Street 1:1283 FOREST GLEN DR S
Practice Address - Street 2:
Practice Address - City:WINNETKA
Practice Address - State:IL
Practice Address - Zip Code:60093-1427
Practice Address - Country:US
Practice Address - Phone:847-446-8790
Practice Address - Fax:847-386-7058
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-17
Last Update Date:2011-12-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036.069604207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine