Individual
ALYSSA BRIE KETCHUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
676 N SAINT CLAIR ST STE 1900, CHICAGO, IL 60611-2986
(312) 926-5354
Mailing address
676 N SAINT CLAIR ST STE 1900, CHICAGO, IL 60611-2986
(312) 926-5354
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
085005549
IL
Other
Enumeration date
07/14/2015
Last updated
12/17/2018
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