Basic Information
| Provider Information | |||||||||
| NPI: | 1174818983 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | PESSIN | ||||||||
| FirstName: | TRACY | ||||||||
| MiddleName: | GAIL | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 339 CONSORT DR | ||||||||
| Address2: | UNIT 1105 | ||||||||
| City: | BALLWIN | ||||||||
| State: | MO | ||||||||
| PostalCode: | 630114439 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6363869224 | ||||||||
| FaxNumber: | 6362004243 | ||||||||
| Practice Location | |||||||||
| Address1: | 5840 S MARYLAND AVE | ||||||||
| Address2: | UCMC DEPARTMENT OF ANESTHESIA AND CRITICAL CARE; MC4028 | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606371462 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7737026700 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/09/2011 | ||||||||
| LastUpdateDate: | 08/08/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207LC0200X | 125.057792 | IL | N | Allopathic & Osteopathic Physicians | Anesthesiology | Critical Care Medicine | 207L00000X | 2016012566 | MO | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.