Individual
NIL URAL III
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2160 S 1ST AVE, 101-1740 LOYOLA UNIVERSITY MEDICAL CENTER, MAYWOOD, IL 60153-3328
(708) 216-9000
(708) 216-9033
Mailing address
2160 S 1ST AVE, 101-1740 LOYOLA UNIVERSITY MEDICAL CENTER, MAYWOOD, IL 60153-3328
(708) 216-9000
(708) 216-9033
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
36100890
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
36100890
—
IL
01
—
K19739
MEDICARE
IL
Enumeration date
01/26/2006
Last updated
10/17/2012
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