Healthcare Provider Details

I. General information

NPI: 1346210978
Provider Name (Legal Business Name): TRACY N LYNDON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 COMMERCE DR SUITE 109
GRAYSLAKE IL
60030-7807
US

IV. Provider business mailing address

15 COMMERCE DR SUITE 109
GRAYSLAKE IL
60030-7807
US

V. Phone/Fax

Practice location:
  • Phone: 847-548-3458
  • Fax: 847-548-3459
Mailing address:
  • Phone: 847-548-3458
  • Fax: 847-548-3459

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: