Provider Demographics
NPI:1851412779
Name:MCDONOUGH, KRISTOPHER MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:KRISTOPHER
Middle Name:MICHAEL
Last Name:MCDONOUGH
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Gender:M
Credentials:MD
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Mailing Address - Street 1:903 N 129TH INFANTRY DR
Mailing Address - Street 2:SUITE #400
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-3171
Mailing Address - Country:US
Mailing Address - Phone:815-725-2653
Mailing Address - Fax:815-744-3232
Practice Address - Street 1:903 N 129TH INFANTRY DR
Practice Address - Street 2:SUITE #400
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-3171
Practice Address - Country:US
Practice Address - Phone:815-725-2653
Practice Address - Fax:815-744-3232
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2009-11-30
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Provider Licenses
StateLicense IDTaxonomies
IL36113500207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL136962Medicare UPIN