DR. MARY L. GANNON (NPI# 1235268541) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1235268541 |
| Entity Type | Individual |
| Full Name | DR. MARY L. GANNON |
| Credential | M.D.,C.A.D.C. |
| Practice Address |
2625 Butterfield Rd Suite 103 W Oak Brook IL 60523-1234 |
| Mailing Address |
326 Grandview Ave Glen Ellyn IL 60137-5220 |
| Practice Telephone | 6309814886 |
| Mailing Telephone | 6309814886 |
| Enumeration Date | 2007-03-04 |
| Last Update Date | 2011-05-17 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2084A0401X |
Psychiatry & Neurology Specialization: Addiction Medicine |
036068239 | IL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| KY | HUMANA | 133348420017 | 01 |
| KY | MAGELLAN BEHAVIORAL HEALT | 234667000 | 01 |
| KY | CORPHEALTH | GANNMARY | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821337445 | Mary E Gannon | Counselor | 1385 King Ave, Columbus, OH 43212-2220 | 2013-02-01 |
| 1225014541 | Mary F Gannon | Physician Assistant | Elm and Carlton St, Buffalo, NY 14263-0001 | 2005-12-19 |
| Street Address |
2625 BUTTERFIELD RD SUITE 103 W |
| City | OAK BROOK |
| State | IL |
| Zip Code | 60523-1234 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023016565 | Yvonne D. Anderson | Counselor | 2625 Butterfield Rd, Suite 101w, Oak Brook, IL 60523-1234 | 2005-07-08 |
| 1235790106 | Bryan Beranard Mullaney | Nurse Practitioner | 2625 Butterfield Rd, Oak Brook, IL 60523-1234 | 2019-06-21 |
| 1689232282 | Elyssa Cyle Thompson | Social Worker | 2625 Butterfield Rd, Oak Brook, IL 60523-1234 | 2019-05-30 |
| 1245722008 | Stephanie Mann | Social Worker | 2625 Butterfield Rd, Oak Brook, IL 60523-1234 | 2018-06-06 |
| 1043720469 | Wendy Lorena Umana | Registered Nurse | 2625 Butterfield Rd, Oak Brook, IL 60523-1234 | 2017-10-11 |
| 1164962502 | Kim Delayne Grant | Psychologist | 2625 Butterfield Rd, Suite 101n, Oak Brook, IL 60523-1234 | 2017-03-05 |
| 1356881296 | Latasha Brown | Counselor | 2625 Butterfield Rd, Suite 101n, Oak Brook, IL 60523-1234 | 2017-02-25 |
| 1639615594 | Shawn Singh | Chiropractor | 2625 Butterfield Rd, Ste 301n, Oak Brook, IL 60523-1234 | 2017-01-16 |
| 1861936478 | Juliane Klinke | Social Worker | 2625 Butterfield Rd, 101n, Oak Brook, IL 60523-1234 | 2016-12-15 |
| 1003359340 | Mulso Associates Counseling, Ltd | Counselor | 2625 Butterfield Rd, Suite 138s, Oak Brook, IL 60523-1234 | 2016-11-18 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194358630 | Jennifer Renee Earnest | Counselor | 2526 Butterfield Road, Suite 138s, Oakbrook, IL 60523 | 2020-02-12 |
| 1881244614 | Meredith Elise Osborne | Pain Medicine | Joint Relief Institute, 600 22nd Street, Oak Brook, IL 60523 | 2019-09-13 |
| 1811450349 | Jessica A Kras | Physical Therapist | 2011 York Rd., Suite 1500, Oak Brook, IL 60523 | 2019-04-11 |
| 1356804876 | Derek M Jones | Physical Therapist | 2011 N. York Rd., Suite 1500, Oak Brook, IL 60523 | 2019-04-11 |
| 1013439975 | Lydia Schatzel | Counselor | 1520 Kensington Rd Ste 212, Oak Brook, IL 60523 | 2017-07-12 |
| 1821537358 | The Anxiety Treatment Center - Western Suburbs, LLC | Counselor | 1100 Jorie Blvd, 227, Oak Brook, IL 60523 | 2017-02-16 |
| 1265989875 | Advance Inpatient Medicine LLC | Hospitalist | 903 Commerce Drive, Suite 333, Oak Brook, IL 60523 | 2016-09-01 |
| 1154877850 | Sandhya Jayaram Shetty | Specialist/Technologist, Other | 1420 Kensington Rd., 201, Oak Brook, IL 60523 | 2016-09-01 |
| 1801349196 | Delsaz Sultan | Dentist | 1301 W 22nd St Ste 1007, Oak Brook, IL 60523 | 2016-08-03 |
| 1851753636 | Pallan Primary Care Ltd S C | Family Medicine | 2425 W 22nd St Ste 211, Oak Brook, IL 60523 | 2016-03-22 |
| Find all providers in zip 60523 | ||||
| Taxonomy Code | 2084A0401X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Psychiatry & Neurology |
| Specialization | Addiction Medicine |
| A doctor of osteopathy board eligible/certified in the field of Psychiatry by the American Osteopathic Board of Neurology and Psychiatry is able to obtain a Certificate of Added Qualifications in the field of Addiction Medicine |
| Notes: Source: American Osteopathic Board of Neurology and Psychiatry, 2007 [1/1/2008: definition added, source added; 7/1/2011: modified source] - Additional Resources: http://www.osteopathic.org/certification |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144741844 | Rose Medical Association, Inc. | Psychiatry & Neurology | 209 W Romeo B Garrett Ave, Peoria, IL 61605-2502 | 2017-07-03 |
| 1215208491 | Fred M Levin Md Sc | Psychiatry & Neurology | 111 N. Wabash Avenue, Suite 1022, Chicago, IL 60602-1903 | 2012-01-20 |
| 1568525277 | Usha D Malkerneker | Psychiatry & Neurology | 17100 Dixie Hwy Ste D, Hazel Crest, IL 60429-1485 | 2006-12-18 |
| 1891899258 | Kenneth Lawrence Moore | Psychiatry & Neurology | 12 Tartan Ridge Rd, Burr Ridge, IL 60527-8904 | 2006-09-07 |
| 1508979758 | Charles R Harris | Psychiatry & Neurology | 12230 Cashlenan Ln, New Lenox, IL 60451-2799 | 2006-08-15 |
| 1255340097 | Michael Rachman | Psychiatry & Neurology | 1375 E Schaumburg Road, Suite 260, Schaumburg, IL 60194-3658 | 2006-08-07 |
| 1245217959 | Raymond Christopher Garcia | Psychiatry & Neurology | 8616 Northern Ave, Rockford, IL 61107-5309 | 2005-12-23 |
| 1184610107 | Lucy Ibrahim | Psychiatry & Neurology | 1280 Windham Pkwy, Romeoville, IL 60446-1673 | 2005-09-26 |
| 1528681764 | Holon Inclusive Behavioral Health | Psychiatry & Neurology | 301 S Main St, Dupo, IL 62239-1325 | 2020-05-21 |
| 1013555416 | Mathers Recovery LLC | Psychiatry & Neurology | 81 E Grand Ave, Fox Lake, IL 60020-1557 | 2019-12-16 |
| Find all providers with the same taxonomy | ||||
Please comment or provide details below to improve the information on DR. MARY L. GANNON.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.