Individual
IRA SENDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
155 E BRUSH HILL RD, ELMHURST, IL 60126-5658
(331) 221-0200
Mailing address
1165 PAYSPHERE CIR, CHICAGO, IL 60674-0011
(630) 734-0200
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
036-062610
IL
Other
Enumeration date
08/10/2006
Last updated
02/21/2014
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