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Individual

IVA ELLIOTT

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
4119 S WABASH AVE APT 2, CHICAGO, IL 60653-2122
(312) 914-3280
Mailing address
4119 S WABASH AVE APT 2, CHICAGO, IL 60653-2122
(312) 914-3280

Taxonomy

Speciality
Code
Description
License number
State
302F00000X
Exclusive Provider Organization
Primary

Other

Enumeration date
05/12/2017
Last updated
05/12/2017
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