Healthcare Provider Details

I. General information

NPI: 1780027441
Provider Name (Legal Business Name): ALICIA D BOYKIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2013
Last Update Date: 10/22/2025
Certification Date: 10/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4822 S COTTAGE GROVE AVE STE 2-200
CHICAGO IL
60615
US

IV. Provider business mailing address

4822 S COTTAGE GROVE AVE STE 2-200
CHICAGO IL
60615
US

V. Phone/Fax

Practice location:
  • Phone: 312-926-7337
  • Fax: 312-921-1191
Mailing address:
  • Phone: 312-926-7337
  • Fax: 312-921-1191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036-150597
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code2083A0300X
TaxonomyAddiction Medicine (Preventive Medicine) Physician
License Number01094073A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number01094073A
License Number StateIN
# 4
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberMD457368
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: