Registry details
Type
Individual
Primary specialty
Anesthesiology
Enumerated
May 20, 2015
License(s)
036153171 (IL), 35.148781 (OH), 125067937 (IL)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| MAILING | 251 E HURON ST # F5-704 | Chicago, IL 60611-2908 | 312-695-0116 |
| LOCATION | 5841 S MARYLAND AVE | Chicago, IL 60637-1443 | 888-824-0200 |
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.