Individual
QI CUI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
5841 S MARYLAND AVE, CHICAGO, IL 60637-1447
(773) 702-1000
Mailing address
13615 W LISBON RD, BROOKFIELD, WI 53005-1227
(773) 603-3836
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
036-120138
IL
Other
Enumeration date
10/28/2008
Last updated
02/11/2022
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