Provider Demographics
NPI:1386135820
Name:MEGHANN HENNELLY MD LLC
Entity type:Organization
Organization Name:MEGHANN HENNELLY MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE-MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MEGHANN
Authorized Official - Middle Name:
Authorized Official - Last Name:HENNELLY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-732-6373
Mailing Address - Street 1:122 S MICHIGAN AVE STE 1025
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60603-6264
Mailing Address - Country:US
Mailing Address - Phone:312-965-1165
Mailing Address - Fax:
Practice Address - Street 1:122 S MICHIGAN AVE STE 1025
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60603-6264
Practice Address - Country:US
Practice Address - Phone:312-965-1165
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-21
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.1358342084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty