Provider Demographics
NPI:1841214749
Name:MEYER-MCLOONE, TRACEY IRENE (MD)
Entity Type:Individual
Prefix:
First Name:TRACEY
Middle Name:IRENE
Last Name:MEYER-MCLOONE
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 1:7714 106TH AVE
Mailing Address - Street 2:
Mailing Address - City:COAL VALLEY
Mailing Address - State:IL
Mailing Address - Zip Code:61240-9646
Mailing Address - Country:US
Mailing Address - Phone:309-799-7022
Mailing Address - Fax:
Practice Address - Street 1:515 VALLEY VIEW DR
Practice Address - Street 2:SUITE 103
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-6175
Practice Address - Country:US
Practice Address - Phone:309-757-1252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILG40319Medicare UPIN
ILK07202/209205Medicare ID - Type Unspecified