Individual
JONATHAN BACOS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
STUDENT
Contact information
Practice address
240 E HURON ST, SUITE 1-200, CHICAGO, IL 60611-2909
(312) 503-7975
Mailing address
8701 W WATERTOWN PLANK RD, MILWAUKEE, WI 53226-3548
(414) 955-4578
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
B22043894236
IL
Other
Enumeration date
08/17/2016
Last updated
03/25/2020
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