Individual
AMIYA PORTIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
219 W CHICAGO AVE, CHICAGO, IL 60654-5600
(872) 777-8110
Mailing address
219 W CHICAGO AVE, CHICAGO, IL 60654-5600
(872) 777-8110
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
11/10/2023
Last updated
11/10/2023
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