Mary L. Gannon, M.D.,C.A.D.C.

Primary specialty

Addiction Medicine (Psychiatry & Neurology) PhysicianTaxonomy code 2084A0401X

License

036068239 Issued in IL

Practice address

2625 Butterfield Rd
Suite 103 W
Oak Brook, IL 60523-1234

Phone

(630) 981-4886

NPI assigned

Mar 4, 2007

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1172966400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1305590400000",
    "number": "1235268541",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "326 GRANDVIEW AVE",
            "city": "GLEN ELLYN",
            "state": "IL",
            "postal_code": "601375220",
            "telephone_number": "630-981-4886"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2625 BUTTERFIELD RD",
            "address_2": "SUITE 103 W",
            "city": "OAK BROOK",
            "state": "IL",
            "postal_code": "605231234",
            "telephone_number": "630-981-4886"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GANNON",
        "first_name": "MARY",
        "middle_name": "L.",
        "name_prefix": "Dr.",
        "credential": "M.D.,C.A.D.C.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-03-04",
        "last_updated": "2011-05-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084A0401X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Addiction Medicine",
            "state": "IL",
            "license": "036068239",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MAGELLAN BEHAVIORAL HEALT",
            "identifier": "234667000",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HUMANA",
            "identifier": "133348420017",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CORPHEALTH",
            "identifier": "GANNMARY",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kenya Galloway, RBT
• Gandhi Mohandas Gutta, M.D.S.C
• Manish R Gandhi, DDS
• Nayan V Gandhi, M.D.
• Mark Robert Gannon, PT
• Jessica L Garcia, MD
• Kelly Suzanne Garcia, BSN, RN, FNP-BC
• Isaiah V Gardiner
• Beth Gasaway, LCPC
• Samanthia Gaspar

• Addiction Medicine (Psychiatry & Neurology) Physician in Oak Brook, IL
• Providers in Oak Brook, IL by specialty
• Addiction Medicine (Psychiatry & Neurology) Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.