DR. MARY KATHLEEN MCTIGUE (NPI# 1578567343) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1578567343 |
| Entity Type | Individual |
| Full Name | DR. MARY KATHLEEN MCTIGUE |
| Credential | M.D. |
| Practice Address |
1200 S Rogers St Bloomington IN 47403-4792 |
| Practice Telephone | 8123396434 |
| Practice Fax Number | 8123310196 |
| Mailing Telephone | 8123396434 |
| Mailing Fax Number | 8123310196 |
| Enumeration Date | 2005-06-09 |
| Last Update Date | 2020-06-11 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207N00000X | Dermatology | 01039092A | IN | Allopathic & Osteopathic Physicians |
| N | 207ND0101X |
Dermatology Specialization: MOHS-Micrographic Surgery |
01039092A | IN | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IN | 100345180 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396122578 | Mary Mctigue | Nurse Practitioner | 222 S Woods Mill Rd, Suite 580s, Chesterfield, MO 63017-3625 | 2015-04-27 |
| Street Address |
1200 S ROGERS ST |
| City | BLOOMINGTON |
| State | IN |
| Zip Code | 47403-4792 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184000531 | Roxanne Rajaii | Dermatology | 1200 S Rogers St, Bloomington, IN 47403-4792 | 2015-08-08 |
| 1669867669 | Michelle Gita Baechtold | Dermatology | 1200 S Rogers St, Bloomington, IN 47403-4792 | 2015-04-06 |
| 1316220296 | Mandy D Wever | Nurse Practitioner | 1200 S Rogers St, Bloomington, IN 47403-4792 | 2011-09-27 |
| 1790944742 | Claudia Irene Vidal | Pathology | 1200 S Rogers St, Bloomington, IN 47403-4792 | 2008-06-05 |
| 1801063128 | Carrie Lynn Davis | Dermatology | 1200 S Rogers St, Bloomington, IN 47403-4792 | 2008-05-15 |
| 1689846909 | Talley Bhanyang Whang | Dermatology | 1200 S Rogers St, Bloomington, IN 47403-4792 | 2008-03-26 |
| 1659451755 | Dermatology Center of Southern Indiana, P.C. | Specialist | 1200 S Rogers St, Bloomington, IN 47403-4792 | 2006-10-16 |
| 1811007495 | Veneda K Vann | Dermatology | 1200 S Rogers St, Bloomington, IN 47403-4792 | 2006-08-30 |
| 1235155722 | Staci C Murphy | Dermatology | 1200 S Rogers St, Bloomington, IN 47403-4792 | 2006-07-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043783673 | Brook Whitaker | Registered Nurse | 4011 S. Monroe Medical Park Blvd, Bloomington, IN 47403 | 2019-01-07 |
| 1598251175 | Jacob Edward Lundorf | Nurse Practitioner | 2100 S Liberty Dr Ste B, Bloomington, IN 47403 | 2018-07-06 |
| 1568973717 | Gregory Thomas Dougan | Physician Assistant | 418 South Landmark Avenue, Bloomington, IN 47403 | 2017-10-16 |
| 1295276160 | Indiana Center for Recovery, LLC | Substance Abuse Rehabilitation Facility | 1004 W 1st Street, Bloomington, IN 47403 | 2017-03-13 |
| 1144694217 | Kayla Dewolf | Specialist/Technologist | 1471 W Allen St, Bloomington, IN 47403 | 2015-11-30 |
| 1164806444 | Monroe Hosoital | General Acute Care Hospital | 4011 Monroe Medical Park, Bloomington, IN 47403 | 2015-07-16 |
| 1821411588 | Jennifer Turner | Occupational Therapy Assistant | 1023 West Main St, Swiss Villa, Vevay, IN 47403 | 2014-01-30 |
| 1104170232 | Kendall Basore | Social Worker | 445 S. Landmark Ave., Bloomington, IN 47403 | 2012-10-26 |
| 1568715886 | Indiana Hearing LLC | Hearing Aid Equipment | 2019 S Liberty Dr, Bloomington, IN 47403 | 2012-10-24 |
| 1679870232 | Accurate Hearing Services | Clinic/Center | 1355 W Second St, #3, Bloomington, IN 47403 | 2011-02-17 |
| Find all providers in zip 47403 | ||||
| Taxonomy Code | 207N00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Dermatology |
| A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source] Additional Resources: American Board of Dermatology, 2007. http://www.abderm.org/ Board certification is provided by the American Board of Dermatology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740415777 | Adrienne Schupbach | Dermatology | 3024 E Empire St Ste E&f, Bloomington, IL 61704-5402 | 2009-05-19 |
| 1003914920 | Bloomington Dermatology Clinic | Dermatology | 2001 E 3rd St, Bloomington, IN 47401-7890 | 2006-09-21 |
| 1528008414 | Rajagopala Swaminathan | Dermatology | 3024 E Empire St Ste Eandf, Bloomington, IL 61704-5402 | 2006-06-08 |
| 1366442444 | Kent S. Taulbee | Dermatology | 2418 E Lincoln St, Bloomington, IL 61701-5915 | 2005-07-29 |
| 1184000531 | Roxanne Rajaii | Dermatology | 1200 S Rogers St, Bloomington, IN 47403-4792 | 2015-08-08 |
| 1669867669 | Michelle Gita Baechtold | Dermatology | 1200 S Rogers St, Bloomington, IN 47403-4792 | 2015-04-06 |
| 1144489618 | Elizabeth Kim Farhat | Dermatology | 7920 Old Cedar Ave S, Bloomington, MN 55425-1207 | 2008-06-09 |
| 1801063128 | Carrie Lynn Davis | Dermatology | 1200 S Rogers St, Bloomington, IN 47403-4792 | 2008-05-15 |
| 1689846909 | Talley Bhanyang Whang | Dermatology | 1200 S Rogers St, Bloomington, IN 47403-4792 | 2008-03-26 |
| 1689863904 | Associates In Dermatology Sc | Dermatology | 1404 Eastland Drive, Suite 204, Bloomington, IL 61701-3532 | 2007-10-23 |
| Find all providers in BLOOMINGTON | ||||
| City | BLOOMINGTON |
| Zip Code | 47403 |
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| 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.