Provider Demographics
NPI:1356365779
Name:MCCOY, DAWN K (MD)
Entity type:Individual
Prefix:
First Name:DAWN
Middle Name:K
Last Name:MCCOY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:611 W PARK ST
Mailing Address - Street 2:BWPC
Mailing Address - City:URBANA
Mailing Address - State:IL
Mailing Address - Zip Code:61801-2529
Mailing Address - Country:US
Mailing Address - Phone:217-383-6792
Mailing Address - Fax:217-383-4752
Practice Address - Street 1:1701 W. CURTIS ROAD
Practice Address - Street 2:FAMILY MEDICINE/CONVENIENT CARE
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61822
Practice Address - Country:US
Practice Address - Phone:217-365-6201
Practice Address - Fax:217-326-1234
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2014-05-07
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Provider Licenses
StateLicense IDTaxonomies
IL036109796207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1356365779OtherNPI
IL1356365779OtherNPI
O07875Medicare UPIN
6447860004Medicare NSC
ILI07875Medicare UPIN
ILIL3270258Medicare PIN