Registry details
Type
Individual
Primary specialty
Surgery
Enumerated
Sep 1, 2016
License(s)
036174741 (IL), 125.076133 (IL)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| LOCATION | 240 E HURON ST SUITE 1-200 | Chicago, IL 60611-2909 | 312-503-7975 |
| MAILING | 240 E HURON ST SUITE 1-200 | Chicago, IL 60611-2909 | 312-503-7975 |
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