Provider Demographics
NPI:1104896414
Name:MCGEE, DAMIAN MICHELLE (MD)
Entity type:Individual
Prefix:DR
First Name:DAMIAN
Middle Name:MICHELLE
Last Name:MCGEE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4535 S KING DR
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60653-4114
Mailing Address - Country:US
Mailing Address - Phone:312-420-3144
Mailing Address - Fax:
Practice Address - Street 1:3916 N DAMEN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-3906
Practice Address - Country:US
Practice Address - Phone:773-644-1362
Practice Address - Fax:773-828-4849
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-26
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.133829208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1587125Medicaid
LA4J997Medicare ID - Type Unspecified