Individual
MR. TERRENCE P. DONOVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.-C
Contact information
Practice address
1501 S CALIFORNIA AVE, CHICAGO, IL 60608-1732
(773) 257-6770
Mailing address
5455 N SHERIDAN RD, CHICAGO, IL 60640-1958
(773) 398-1656
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085-002034
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
085-002034
STATE LICENSE
IL
Enumeration date
12/05/2006
Last updated
01/05/2009
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