Provider Demographics
NPI:1033161435
Name:MUHAMMAD, TRACY LARKINS (MD)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:LARKINS
Last Name:MUHAMMAD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:654 E 47TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60653-4224
Mailing Address - Country:US
Mailing Address - Phone:773-624-4800
Mailing Address - Fax:773-624-5028
Practice Address - Street 1:3401 N PERRYVILLE RD
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61114-8011
Practice Address - Country:US
Practice Address - Phone:815-971-2000
Practice Address - Fax:815-968-9340
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-115295207R00000X
NC2018-02066207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036-115295OtherSTATE LICENSE