Individual
MELISSA YUWONO TJOTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD, PHD
Contact information
Practice address
5841 S MARYLAND AVE # MC1052, CHICAGO, IL 60637-1447
(773) 834-7708
(773) 702-1119
Mailing address
180 HARVESTER DR STE 110, BURR RIDGE, IL 60527-6686
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
125070624
IL
Other
Enumeration date
05/26/2017
Last updated
05/26/2017
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