Individual
KALYNA PETRUSHA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
3924 W FULLERTON AVE, CHICAGO, IL 60647-2228
(773) 276-2229
Mailing address
685 W WRIGHTWOOD AVE APT 2S, CHICAGO, IL 60614-7969
(248) 703-4782
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085.008427
IL
Other
Enumeration date
02/19/2020
Last updated
10/19/2021
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