Provider Demographics
NPI:1639154370
Name:TRACY, MELISSA JOY (MD)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:JOY
Last Name:TRACY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1725 W HARRISON ST
Mailing Address - Street 2:SUITE 1159
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-3841
Mailing Address - Country:US
Mailing Address - Phone:312-942-5020
Mailing Address - Fax:312-563-7475
Practice Address - Street 1:1725 W HARRISON ST
Practice Address - Street 2:SUITE 1159
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3841
Practice Address - Country:US
Practice Address - Phone:312-942-5020
Practice Address - Fax:312-563-7475
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2013-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-131926207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
G82911Medicare UPIN