Individual
LEA FUCYDZY KIOUTAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
13100 VINEYARD DR, HUNTLEY, IL 60142
(847) 814-4007
(847) 814-4007
Mailing address
13100 VINEYARD DR, HUNTLEY, IL 60142
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
36-054274
IL
Other
Enumeration date
01/12/2010
Last updated
01/12/2010
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