Registry details
Type
Individual
Primary specialty
Physician Assistant, Medical
Enumerated
Jul 20, 2006
License(s)
036071354 (IL)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| MAILING | 5100 RELIABLE PKWY | Chicago, IL 60686-0001 | 309-672-4240 |
| LOCATION | 525 SWEETBRIAR DR | Chillicothe, IL 61523 | 309-274-2102 |
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.