Provider Demographics
NPI:1235524364
Name:MC KINLEY, JAMIE
Entity Type:Individual
Prefix:MR
First Name:JAMIE
Middle Name:
Last Name:MC KINLEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1307 W LINCOLN HWY APT 7104
Mailing Address - Street 2:
Mailing Address - City:DEKALB
Mailing Address - State:IL
Mailing Address - Zip Code:60115-2953
Mailing Address - Country:US
Mailing Address - Phone:773-828-0020
Mailing Address - Fax:630-369-7067
Practice Address - Street 1:1101 W NORTH AVE
Practice Address - Street 2:
Practice Address - City:MELROSE PARK
Practice Address - State:IL
Practice Address - Zip Code:60160-1526
Practice Address - Country:US
Practice Address - Phone:708-731-4400
Practice Address - Fax:708-344-7329
Is Sole Proprietor?:No
Enumeration Date:2015-04-06
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program