Provider Demographics
NPI:1619019148
Name:PARKS, JOANNE GAIL (MD)
Entity Type:Individual
Prefix:DR
First Name:JOANNE
Middle Name:GAIL
Last Name:PARKS
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 1:26400 W FALKIRK CIR
Mailing Address - Street 2:
Mailing Address - City:BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010-2865
Mailing Address - Country:US
Mailing Address - Phone:847-542-9780
Mailing Address - Fax:224-655-2910
Practice Address - Street 1:26400 W FALKIRK CIR
Practice Address - Street 2:
Practice Address - City:BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-2865
Practice Address - Country:US
Practice Address - Phone:847-542-9780
Practice Address - Fax:224-655-2910
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360862702084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL364030461OtherFEIN
IL0490572803OtherBLUE CROSS BLUE SHIELD
ILF53622Medicare UPIN
IL597210Medicare ID - Type UnspecifiedPROVIDER NUMBER