Provider Demographics
NPI:1699727503
Name:MCINERNEY, JOHN VINCENT (DO)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:VINCENT
Last Name:MCINERNEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:9800 S LONGWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60643-1706
Mailing Address - Country:US
Mailing Address - Phone:773-779-4548
Mailing Address - Fax:
Practice Address - Street 1:11824 SOUTHWEST HWY
Practice Address - Street 2:SUITE 200
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463-1055
Practice Address - Country:US
Practice Address - Phone:708-923-1919
Practice Address - Fax:708-923-9922
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2014-08-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036-070352207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
D15007Medicare UPIN
D15007Medicare UPIN