Provider Demographics
NPI:1528280088
Name:MCCOY, RICHARD MICHAEL
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:MICHAEL
Last Name:MCCOY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:717 GLENDALE DR
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025-4414
Mailing Address - Country:US
Mailing Address - Phone:847-209-0303
Mailing Address - Fax:847-724-5269
Practice Address - Street 1:2525 S MICHIGAN AVE
Practice Address - Street 2:MERCY HOSPITAL AND MEDICAL CENTER
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-2333
Practice Address - Country:US
Practice Address - Phone:312-567-2000
Practice Address - Fax:847-724-5269
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILT37684Medicare UPIN
IL671340Medicare ID - Type Unspecified