Provider Demographics
NPI:1053607424
Name:LOUDON, TRACY ANNE (MD)
Entity type:Individual
Prefix:DR
First Name:TRACY
Middle Name:ANNE
Last Name:LOUDON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:TRACY
Other - Middle Name:ANNE
Other - Last Name:HARKENSEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1424 W GRAND AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60642-7418
Mailing Address - Country:US
Mailing Address - Phone:847-909-3695
Mailing Address - Fax:
Practice Address - Street 1:120 N OAK ST
Practice Address - Street 2:
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-3829
Practice Address - Country:US
Practice Address - Phone:630-856-6700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-23
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAA122252207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program