Individual
GEETA BOLLAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
556 E 115TH ST, CHICAGO, IL 60628-5740
(318) 210-1030
Mailing address
301 W GOETHE ST, 301C, CHICAGO, IL 60610-1857
(318) 210-1030
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036.132495
IL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/29/2009
Last updated
11/27/2023
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