Healthcare Provider Details

I. General information

NPI: 1316190721
Provider Name (Legal Business Name): RICKQUEL TRIPP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2008
Last Update Date: 05/24/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5841 S MARYLAND AVE # MC5068 UNIVERSITY OF CHICAGO DEPT OF EMERGENCY MEDICINE
CHICAGO IL
60637-1443
US

IV. Provider business mailing address

5841 S MARYLAND AVE # MC5068 UNIVERSITY OF CHICAGO DEPT OF EMERGENCY MEDICINE
CHICAGO IL
60637-1443
US

V. Phone/Fax

Practice location:
  • Phone: 773-702-9500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number0101246301
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: