Provider Demographics
NPI:1235524364
Name:MC KINLEY, JAMIE
Entity type:Individual
Prefix:MR
First Name:JAMIE
Middle Name:
Last Name:MC KINLEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1313 N WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-5060
Mailing Address - Country:US
Mailing Address - Phone:773-828-0020
Mailing Address - Fax:630-369-7067
Practice Address - Street 1:2157 N DAMEN AVE STE 2C
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-6916
Practice Address - Country:US
Practice Address - Phone:773-278-4769
Practice Address - Fax:773-303-8426
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-06
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator