Provider Demographics
NPI:1407888712
Name:BOYKIN-WILSON, TRACY (MD)
Entity Type:Individual
Prefix:DR
First Name:TRACY
Middle Name:
Last Name:BOYKIN-WILSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:TRACY
Other - Middle Name:
Other - Last Name:BOYKIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2008 S CALUMET AVE
Mailing Address - Street 2:UNIT E
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616-2442
Mailing Address - Country:US
Mailing Address - Phone:312-286-8967
Mailing Address - Fax:
Practice Address - Street 1:2008 S CALUMET AVE
Practice Address - Street 2:UNIT E
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-2442
Practice Address - Country:US
Practice Address - Phone:312-286-8967
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01069591A207P00000X
IL036-102117207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036102117-7Medicaid
ILR01267Medicaid
IL01632243OtherBLUE SHIELD
IL036102117Medicaid
ILR01267Medicaid
ILH24879Medicare UPIN
ILR03139Medicare PIN