Provider Demographics
NPI:1720113103
Name:DARIN, MARY KAY
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:KAY
Last Name:DARIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1805 MIA DR
Mailing Address - Street 2:
Mailing Address - City:CREST HILL
Mailing Address - State:IL
Mailing Address - Zip Code:60435-0933
Mailing Address - Country:US
Mailing Address - Phone:815-773-0895
Mailing Address - Fax:815-773-2115
Practice Address - Street 1:1805 MIA DR
Practice Address - Street 2:
Practice Address - City:CREST HILL
Practice Address - State:IL
Practice Address - Zip Code:60435-0933
Practice Address - Country:US
Practice Address - Phone:815-773-0895
Practice Address - Fax:815-773-2115
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist