Provider Demographics
NPI:1518265875
Name:MECK, CANDICE ELAINE (DO)
Entity Type:Individual
Prefix:DR
First Name:CANDICE
Middle Name:ELAINE
Last Name:MECK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:CANDICE
Other - Middle Name:ELAINE
Other - Last Name:REYES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:1555 N WOOD ST
Mailing Address - Street 2:UNIT 302
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-1180
Mailing Address - Country:US
Mailing Address - Phone:630-334-2368
Mailing Address - Fax:
Practice Address - Street 1:2320 E 93RD ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60617-3909
Practice Address - Country:US
Practice Address - Phone:773-967-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-09
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02004466A207P00000X
IL036.135397207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036135397Medicaid