Provider Demographics
NPI:1740210533
Name:MCDONOUGH, TIMOTHY J (MD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:J
Last Name:MCDONOUGH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1713 CENTRAL ST
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-1507
Mailing Address - Country:US
Mailing Address - Phone:847-869-1499
Mailing Address - Fax:847-869-2932
Practice Address - Street 1:3915 OGLESBY AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-3358
Practice Address - Country:US
Practice Address - Phone:847-336-1600
Practice Address - Fax:847-336-2380
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036050102207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036050102Medicaid
IL036050102Medicaid
IL202886001Medicare PIN