Healthcare Provider Details

I. General information

NPI: 1164693057
Provider Name (Legal Business Name): JOANNE LUCIE MCKELL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/18/2008
Last Update Date: 07/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

840 S WOOD ST M/C 719
CHICAGO IL
60612-4325
US

IV. Provider business mailing address

840 S WOOD ST M/C 719
CHICAGO IL
60612-4325
US

V. Phone/Fax

Practice location:
  • Phone: 312-996-8039
  • Fax:
Mailing address:
  • Phone: 312-996-8039
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number036-111968
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number036-111968
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: