Individual
MRS. MALLORY BETH WEBER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1725 W HARRISON ST, SUITE 809, CHICAGO, IL 60612-3841
(312) 942-5904
(312) 942-3192
Mailing address
2000 OVALTINE CT, APT 309, VILLA PARK, IL 60181-5606
(217) 556-7274
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085006013
IL
Other
Enumeration date
11/10/2016
Last updated
11/10/2016
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