MEDICARE: DR. TRACY BOYKIN-WILSON M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	01069591A	IN
2	207P00000X	Emergency Medicine Physician	036-102117	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	01632243	OTHER	IL	BLUE SHIELD
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407888712
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TRACY BOYKIN-WILSON M.D.

Provider Business Mailing Address
First Line	:	2008 S CALUMET AVE
Second Line	:	UNIT E
City	:	CHICAGO
State	:	IL
Zip	:	60616-2442
Country	:	US
Telephone Number	:	312-286-8967
Fax Number	:

Provider Business Practice Location Address
First Line	:	2008 S CALUMET AVE
Second Line	:	UNIT E
City	:	CHICAGO
State	:	IL
Zip	:	60616-2442
Country	:	US
Telephone Number	:	312-286-8967
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2006
Last Update Date	:	05/17/2022

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