Provider Demographics
NPI:1730365586
Name:MACKLIN, CLAUDETTE MARIE (MD)
Entity type:Individual
Prefix:DR
First Name:CLAUDETTE
Middle Name:MARIE
Last Name:MACKLIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:P.O. BOX 2173
Mailing Address - Street 2:
Mailing Address - City:BEDFORD PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60499-2173
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1701 W MONTEREY AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60643-4257
Practice Address - Country:US
Practice Address - Phone:773-298-9800
Practice Address - Fax:773-298-9901
Is Sole Proprietor?:No
Enumeration Date:2008-01-10
Last Update Date:2009-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-091906207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILG15866Medicare UPIN
ILK27174Medicare PIN