Provider Demographics
NPI:1437228186
Name:BOATWRIGHT, PATRICIA MARY (MD,)
Entity type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:MARY
Last Name:BOATWRIGHT
Suffix:
Gender:F
Credentials:MD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4646 N MARINE DR STE A3300
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-5759
Mailing Address - Country:US
Mailing Address - Phone:312-738-0055
Mailing Address - Fax:773-564-6021
Practice Address - Street 1:4646 N MARINE DR STE A3300
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-5759
Practice Address - Country:US
Practice Address - Phone:312-738-0055
Practice Address - Fax:773-564-6021
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36-3632106207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILC43327Medicare UPIN
IL752511Medicare ID - Type Unspecified