Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 036099299 | IL |
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 036-099299 | IL |
NPI | 1326061839 |
---|---|
Provider Name | Dr. Orlanda B. Mackie |
First Address | Chicago, IL 60620-3824 |
Second Address | Chicago, IL 60612-3714 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2006 |
Last Update Date | 27/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H37405 | (02) | IL |