Registry details
Type
Individual
Primary specialty
Family Medicine
Enumerated
May 19, 2023
License(s)
125083001 (IL)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| LOCATION | 7531 S STONY ISLAND AVE | Chicago, IL 60649-3954 | 773-947-7500 |
| MAILING | 7531 S STONY ISLAND AVE | Chicago, IL 60649-3954 | 773-947-7500 |
Watch this provider
Get a webhook/email the day this provider is added to the OIG-LEIE exclusion list or appears in an FDA enforcement action.