Provider Demographics
NPI:1487842688
Name:LOURY, MYKELA KAROLE (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:MYKELA
Middle Name:KAROLE
Last Name:LOURY
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
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Mailing Address - Street 1:2045 W WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-2428
Mailing Address - Country:US
Mailing Address - Phone:312-413-1789
Mailing Address - Fax:312-413-7812
Practice Address - Street 1:2045 W WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-2428
Practice Address - Country:US
Practice Address - Phone:312-413-1789
Practice Address - Fax:312-413-7812
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-12
Last Update Date:2013-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125053689207Q00000X
IL036088246207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine