Individual
GARY ELEM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
12511 S PRINCETON AVE, CHICAGO, IL 60628-7224
(773) 876-1460
Mailing address
12511 S PRINCETON AVE, CHICAGO, IL 60628-7224
(773) 876-1460
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
—
Other
Enumeration date
06/02/2009
Last updated
01/07/2015
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