Registry details
Type
Individual
Primary specialty
Orthopaedic Surgery
Enumerated
May 20, 2021
License(s)
036179906 (IL), 01099291A (IN), 036179906 (IL), 01099291A (IN)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| MAILING | PO BOX 735263 | Chicago, IL 60673-5263 | |
| LOCATION | 1611 W HARRISON ST STE 400 | Chicago, IL 60612-4861 | 877-632-6637 |
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