Provider Demographics
NPI:1174818983
Name:PESSIN, TRACY GAIL (MD)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:GAIL
Last Name:PESSIN
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 1:339 CONSORT DR
Mailing Address - Street 2:UNIT 1105
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63011-4439
Mailing Address - Country:US
Mailing Address - Phone:636-386-9224
Mailing Address - Fax:636-200-4243
Practice Address - Street 1:5840 S MARYLAND AVE
Practice Address - Street 2:UCMC DEPARTMENT OF ANESTHESIA AND CRITICAL CARE; MC4028
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60637-1462
Practice Address - Country:US
Practice Address - Phone:773-702-6700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-09
Last Update Date:2016-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125.057792207LC0200X
MO2016012566207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LC0200XAllopathic & Osteopathic PhysiciansAnesthesiologyCritical Care Medicine