Individual
DR. DANIEL THEODORE LIS JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
836 W WELLINGTON AVE, CHICAGO, IL 60657-5147
(773) 975-1600
Mailing address
655 W IRVING PARK RD, APT 907, CHICAGO, IL 60613-3123
(248) 890-4955
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
036123897
IL
Other
Enumeration date
06/17/2008
Last updated
12/21/2009
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