Individual
MARY UDOH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4554 N BROADWAY ST, SUITE #333, CHICAGO, IL 60640-5642
(312) 208-7304
Mailing address
4554 N BROADWAY ST, SUITE #333, CHICAGO, IL 60640-5642
(312) 208-7304
Taxonomy
Speciality
Code
Description
License number
State
376J00000X
Homemaker
Primary
3001321
IL
Other
Enumeration date
08/21/2016
Last updated
08/21/2016
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