Provider Demographics
NPI:1669024998
Name:TREACY, LAURA JANSEN (MD)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:JANSEN
Last Name:TREACY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:MACKE
Other - Last Name:JANSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:225 N MILWAUKEE AVE
Mailing Address - Street 2:
Mailing Address - City:VERNON HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60061-4304
Mailing Address - Country:US
Mailing Address - Phone:847-941-7600
Mailing Address - Fax:
Practice Address - Street 1:225 N MILWAUKEE AVE
Practice Address - Street 2:
Practice Address - City:VERNON HILLS
Practice Address - State:IL
Practice Address - Zip Code:60061-4304
Practice Address - Country:US
Practice Address - Phone:847-941-7600
Practice Address - Fax:847-941-7697
Is Sole Proprietor?:No
Enumeration Date:2019-07-16
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IL036165468207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program