Provider Demographics
NPI:1699734186
Name:MCDONAGH, DESMOND B (MD)
Entity type:Individual
Prefix:
First Name:DESMOND
Middle Name:B
Last Name:MCDONAGH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1901 BUTTERFIELD RD
Mailing Address - Street 2:STE 220
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-7915
Mailing Address - Country:US
Mailing Address - Phone:630-725-2768
Mailing Address - Fax:630-725-2783
Practice Address - Street 1:1790 NATIONS DR
Practice Address - Street 2:SUITE #207
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-9164
Practice Address - Country:US
Practice Address - Phone:847-205-9900
Practice Address - Fax:847-205-9905
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2008-05-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL0360462312086S0129X
IL036-046231202K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No202K00000XAllopathic & Osteopathic PhysiciansPhlebology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01622308OtherBXBS
C44322Medicare UPIN
ILL29104Medicare PIN