Individual
JAY DECLARADOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
332 S MICHIGAN AVE, CHICAGO, IL 60604-4434
(888) 660-4425
Mailing address
5450 ASTOR LN APT 418, ROLLING MEADOWS, IL 60008-4116
(847) 259-7173
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
209016591
IL
Other
Enumeration date
11/10/2017
Last updated
11/10/2017
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