Provider Demographics
NPI:1831341908
Name:MCGRAIL, MICHAEL J (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:J
Last Name:MCGRAIL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3860 W 95TH ST
Mailing Address - Street 2:SUITE 6
Mailing Address - City:EVERGREEN PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60805-2034
Mailing Address - Country:US
Mailing Address - Phone:708-425-3900
Mailing Address - Fax:708-425-3939
Practice Address - Street 1:3860 W 95TH ST
Practice Address - Street 2:SUITE 6
Practice Address - City:EVERGREEN PARK
Practice Address - State:IL
Practice Address - Zip Code:60805-2034
Practice Address - Country:US
Practice Address - Phone:708-425-3900
Practice Address - Fax:708-425-3939
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-21
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL336082703207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036-068995OtherSTATE LICENSE
ILIL1901Medicare Oscar/Certification