Registry details
Type
Individual
Primary specialty
Physician Assistant
Enumerated
Apr 14, 2017
License(s)
6801098845 (MI), 085.009495 (IL), 085009495 (IL)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| MAILING | 641 W 63RD ST | Chicago, IL 60621-2032 | 773-388-1600 |
| LOCATION | 641 W 63RD ST | Chicago, IL 60621-2032 | 773-388-1600 |
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