Individual
MRS. TRACEE A BLACKBURN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1460 NORTH HALSTED STREET, SUITE 505, CHICAGO, IL 60642
(312) 266-6462
(312) 266-6481
Mailing address
1460 NORTH HALSTED STREET, SUITE 505, CHICAGO, IL 60642
(312) 266-6462
(312) 266-6481
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
085-002507
IL
2080A0000X
Pediatric Adolescent Medicine Physician
085-002507
IL
Other
Enumeration date
07/06/2006
Last updated
12/22/2016
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