Individual
DEANNE C FORNELLI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1653 W. CONGRESS PARKWAY, JELKE 7TH FLOOR - GENERAL SURGERY, CHICAGO, IL 60612
(312) 942-6379
Mailing address
1653 W. CONGRESS PARKWAY, JELKE 7TH FLOOR - GENERAL SURGERY, CHICAGO, IL 60612
(312) 942-6379
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
085.003925
IL
Other
Enumeration date
12/01/2010
Last updated
09/11/2012
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