Individual
ALUA DOSMURATOVA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
8915 OLCOTT AVE, MORTON GROVE, IL 60053-1917
(847) 769-7494
Mailing address
8915 OLCOTT AVE, MORTON GROVE, IL 60053-1917
(847) 769-7494
Taxonomy
Speciality
Code
Description
License number
State
347E00000X
Transportation Broker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
D25601194824
—
IL
Enumeration date
04/09/2018
Last updated
04/09/2018
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