Individual
BIANCA ALEXANDRIA DOHERTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2073 N CLYBOURN AVE, CHICAGO, IL 60614-4003
(773) 665-4016
(773) 360-6200
Mailing address
3909 N WESTERN AVE, CHICAGO, IL 60618-3741
(773) 739-9200
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085.006228
IL
Other
Enumeration date
08/03/2017
Last updated
11/20/2017
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