Registry details
Type
Individual
Primary specialty
Physician Assistant, Surgical
Enumerated
Feb 27, 2026
License(s)
238.010972 (IL), 238.010972 (IL)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| MAILING | 19015 S JODI RD STE H | Mokena, IL 60448-8534 | 708-994-5418 |
| LOCATION | 19015 S JODI RD STE H | Mokena, IL 60448-8534 | 708-994-5418 |
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