Individual
JERIES NICOLA KAHOUSH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
939 W MADISON ST, CHICAGO, IL 60607-2638
(312) 548-0601
(312) 277-7475
Mailing address
12834 S APPLE LN, ALSIP, IL 60803-2735
(773) 531-5269
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
227.018078
IL
Other
Enumeration date
07/18/2015
Last updated
07/18/2015
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