Organization
AISHA LANE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PAMELA CLAY (BILLING MANAGER)
(888) 265-9908
Entity
Organization
Contact information
Practice address
7900 W 75TH ST, BRIDGEVIEW, IL 60455-1237
(708) 612-3956
(888) 265-5564
Mailing address
6801 W 73RD ST UNIT 922, BEDFORD PARK, IL 60499-5332
(708) 612-3956
(888) 265-5564
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
—
—
Other
Enumeration date
04/18/2019
Last updated
06/06/2019
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