Individual
AMY LISS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
9921 SOUTHWEST HWY, OAK LAWN, IL 60453-3754
(708) 499-5678
Mailing address
9921 SOUTHWEST HWY, OAK LAWN, IL 60453-3754
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085006265
IL
Other
Enumeration date
11/30/2017
Last updated
06/03/2020
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