Provider Demographics
NPI:1770270951
Name:MCDOWELL, MOLLY HUGHES
Entity type:Individual
Prefix:MRS
First Name:MOLLY
Middle Name:HUGHES
Last Name:MCDOWELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 N EDGEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60526-5510
Mailing Address - Country:US
Mailing Address - Phone:708-601-4896
Mailing Address - Fax:
Practice Address - Street 1:8100 W 119TH STREET
Practice Address - Street 2:
Practice Address - City:PALOS PARK
Practice Address - State:IL
Practice Address - Zip Code:60464-3080
Practice Address - Country:US
Practice Address - Phone:708-361-3300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-19
Last Update Date:2023-11-02
Deactivation Date:2023-08-15
Deactivation Code:
Reactivation Date:2023-08-28
Provider Licenses
StateLicense IDTaxonomies
IL209.028047363LF0000X, 208000000X
IL209028047363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily