Individual
JOY A DERUSHA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
1029 EAST 130TH STREET, CHICAGO, IL 60643-4039
(773) 387-2519
Mailing address
1029 EAST 130TH STREET, CHICAGO, IL 60643-4039
(773) 995-6300
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085.002734
IL
363AM0700X
Medical Physician Assistant
10000869A
IN
Other
Enumeration date
06/19/2007
Last updated
06/05/2015
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