Healthcare Provider Details

I. General information

NPI: 1043701485
Provider Name (Legal Business Name): ADRIENNE B MEJIA MD MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2018
Last Update Date: 03/03/2026
Certification Date: 03/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4201 W MEDICAL CENTER DR
MCHENRY IL
60050-8409
US

IV. Provider business mailing address

164 N PEORIA ST APT 3005
CHICAGO IL
60607-2372
US

V. Phone/Fax

Practice location:
  • Phone: 815-344-5000
  • Fax: 815-344-3347
Mailing address:
  • Phone: 203-688-4242
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number036160694
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: