Provider Demographics
NPI:1295883551
Name:MCDERMOTT, RAYMOND A III (MD)
Entity type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:A
Last Name:MCDERMOTT
Suffix:III
Gender:M
Credentials:MD
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Mailing Address - Street 1:2740 W FOSTER AVE
Mailing Address - Street 2:STE LL7
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-3543
Mailing Address - Country:US
Mailing Address - Phone:773-878-8200
Mailing Address - Fax:773-293-4197
Practice Address - Street 1:111 N WABASH
Practice Address - Street 2:#1717
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602
Practice Address - Country:US
Practice Address - Phone:312-346-6330
Practice Address - Fax:312-346-5940
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2020-10-30
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Provider Licenses
StateLicense IDTaxonomies
IL036063846207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036063846Medicaid
E41587Medicare UPIN
IL036063846Medicaid