Provider Demographics
NPI:1700938420
Name:FRANKLIN, PAMELA MITCHELL (MD)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:MITCHELL
Last Name:FRANKLIN
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 1:5035 S EAST END AVE
Mailing Address - Street 2:APT 3310N
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60615-0131
Mailing Address - Country:US
Mailing Address - Phone:773-288-1398
Mailing Address - Fax:773-288-8193
Practice Address - Street 1:3303 S HALSTED ST
Practice Address - Street 2:STE 207
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60608-6877
Practice Address - Country:US
Practice Address - Phone:773-633-2543
Practice Address - Fax:773-420-3494
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036052464207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036052464Medicaid
D 14063Medicare UPIN
IL036052464Medicaid