Provider Demographics
NPI:1326061839
Name:MACKIE, ORLANDA B (MD)
Entity Type:Individual
Prefix:DR
First Name:ORLANDA
Middle Name:B
Last Name:MACKIE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7920 S ELIZABETH ST
Mailing Address - Street 2:APARTMENT # 1
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60620-3824
Mailing Address - Country:US
Mailing Address - Phone:773-488-7950
Mailing Address - Fax:773-348-8234
Practice Address - Street 1:1901 W HARRISON ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3714
Practice Address - Country:US
Practice Address - Phone:312-864-6000
Practice Address - Fax:312-864-9500
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036099299207Q00000X
IL036-099299207QH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILH37405Medicare UPIN