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Individual

CAMILLA Z LARSEN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
2160 S 1ST AVE, MAYWOOD, IL 60153-3328
(708) 216-1116
Mailing address
2160 S 1ST AVE, MAYWOOD, IL 60153-3328

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036108645
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
036108645
IL
01
12419687
CAQH
IL
Enumeration date
08/13/2006
Last updated
02/02/2022
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