Individual
NGA LE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
4440 W 95TH ST, OAK LAWN, IL 60453-2600
(708) 684-3296
(708) 684-3142
Mailing address
4440 W 95TH ST, OAK LAWN, IL 60453-2600
(708) 684-3296
(708) 684-3142
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
125061988
IL
Other
Enumeration date
07/09/2012
Last updated
07/09/2012
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