Basic Information
| Provider Information | |||||||||
| NPI: | 1447205141 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JOYCE | ||||||||
| FirstName: | MARGIE | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 776351 | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606776351 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5029696552 | ||||||||
| FaxNumber: | 5029693799 | ||||||||
| Practice Location | |||||||||
| Address1: | 231 E CHESTNUT ST | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402021821 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5026297661 | ||||||||
| FaxNumber: | 5026295309 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2006 | ||||||||
| LastUpdateDate: | 09/01/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085P0229X | 20846 | KY | Y | Allopathic & Osteopathic Physicians | Radiology | Pediatric Radiology |
ID Information
| ID | Type | State | Issuer | Description | 09314 | 01 | KY | SIHO - KCR | OTHER | 50017082 | 01 | KY | PASSPORT - KCR | OTHER | 2433294000 | 01 | KY | PASSPORT ADVANTAGE - KCR | OTHER | 64208465 | 05 | KY | MEDICAID | 000000545162 | 01 | KY | ANTHEM - KCR | OTHER | 000023029P | 01 | KY | HUMANA - KCR | OTHER | 100357990 | 01 | KY | IN MCD - KCR | OTHER |