Provider Demographics
NPI:1245292283
Name:MEARS, CYNTHIA JANE (DO)
Entity type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:JANE
Last Name:MEARS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:MRS
Other - First Name:CYNTHIA
Other - Middle Name:JANE
Other - Last Name:BACALAO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4440 W 95TH ST STE 1200H
Mailing Address - Street 2:ADVOCATE CHILDRENS HOSPITAL OAK LAWN
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-2600
Mailing Address - Country:US
Mailing Address - Phone:708-684-5341
Mailing Address - Fax:708-684-4716
Practice Address - Street 1:4440 W 95TH ST STE 1200H
Practice Address - Street 2:ADVOCATE CHILDRENS HOSPITAL OAK LAWN
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-2600
Practice Address - Country:US
Practice Address - Phone:708-684-5341
Practice Address - Fax:708-684-4716
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2014-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036092150208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036092150Medicaid
F66138Medicare UPIN
IL036092150Medicaid