Provider Demographics
NPI:1588640940
Name:COMELLA, CYNTHIA L (MD)
Entity Type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:L
Last Name:COMELLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1725 W HARRISON ST
Mailing Address - Street 2:STE 755
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-3841
Mailing Address - Country:US
Mailing Address - Phone:312-563-2900
Mailing Address - Fax:312-563-2024
Practice Address - Street 1:1725 W HARRISON ST
Practice Address - Street 2:STE 755
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3841
Practice Address - Country:US
Practice Address - Phone:312-563-2900
Practice Address - Fax:312-563-2024
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360671442084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036067144Medicaid
IL336031355OtherIL DEPT OF PROF REG
IL336031355OtherIL DEPT OF PROF REG
IL036067144Medicaid
AC2487913OtherDEA