MEDICARE: DR. MELISSA JOY TRACY MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	036-131926	IL

General Provider Information

NPI Number	:	1639154370
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MELISSA JOY TRACY MD

Provider Business Mailing Address
First Line	:	1725 W HARRISON ST
Second Line	:	SUITE 1159
City	:	CHICAGO
State	:	IL
Zip	:	60612-3841
Country	:	US
Telephone Number	:	312-942-5020
Fax Number	:	312-563-7475

Provider Business Practice Location Address
First Line	:	1725 W HARRISON ST
Second Line	:	SUITE 1159
City	:	CHICAGO
State	:	IL
Zip	:	60612-3841
Country	:	US
Telephone Number	:	312-942-5020
Fax Number	:	312-563-7475

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/14/2005
Last Update Date	:	05/02/2013

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