Registry details
Type
Individual
Primary specialty
Physician Assistant, Medical
Enumerated
Oct 4, 2005
License(s)
10004736A (IN), 085-001709 (IL)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| LOCATION | 1501 S CALIFORNIA AVE | Chicago, IL 60608-1732 | 773-257-6843 |
| MAILING | 3537 PAYSPHERE CIR | Chicago, IL 60674-0035 | 708-786-2900 |
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