Individual
CAROL E. TALISSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
5115 N FRANCISCO AVE, CHICAGO, IL 60625-3611
(773) 271-2225
(773) 271-1145
Mailing address
5019 N MOZART ST, CHICAGO, IL 60625-3615
(773) 293-3223
(773) 293-4197
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085003354
IL
363AS0400X
Surgical Physician Assistant
085-003354
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
085-003354
LICENSE
IL
Enumeration date
05/07/2009
Last updated
10/30/2020
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