Provider Demographics
NPI:1821853862
Name:MCAFEE, MERISSA MICHELLE
Entity Type:Individual
Prefix:
First Name:MERISSA
Middle Name:MICHELLE
Last Name:MCAFEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2335 W FULLERTON AVE STE B
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-3225
Mailing Address - Country:US
Mailing Address - Phone:312-300-3882
Mailing Address - Fax:
Practice Address - Street 1:2335 W FULLERTON AVE STE B
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-3225
Practice Address - Country:US
Practice Address - Phone:312-300-3882
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-19
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1770928640207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine