Healthcare Provider Details

I. General information

NPI: 1104896414
Provider Name (Legal Business Name): DAMIAN MICHELLE MCGEE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2006
Last Update Date: 08/20/2021
Certification Date: 08/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3916 N DAMEN AVE
CHICAGO IL
60618-3906
US

IV. Provider business mailing address

4535 S KING DR
CHICAGO IL
60653-4114
US

V. Phone/Fax

Practice location:
  • Phone: 773-644-1362
  • Fax: 773-828-4849
Mailing address:
  • Phone: 312-420-3144
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036.133829
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: