Individual
DR. TRACY BOYKIN-WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2008 S CALUMET AVE, UNIT E, CHICAGO, IL 60616-2442
(312) 286-8967
Mailing address
2008 S CALUMET AVE, UNIT E, CHICAGO, IL 60616-2442
(312) 286-8967
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
01069591A
IN
207P00000X
Emergency Medicine Physician
Primary
036-102117
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01632243
BLUE SHIELD
IL
05
—
036102117
—
IL
05
—
036102117-7
—
IL
05
—
R01267
—
IL
Enumeration date
07/07/2006
Last updated
05/17/2022
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