Individual
SAMANTHA BROOKE MACKAY-FORTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1775 DEMPSTER ST, MAILBOX #48, PARK RIDGE, IL 60068
(847) 723-2210
Mailing address
1775 DEMPSTER ST, MAILBOX #48, PARK RIDGE, IL 60068
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
125.082838
IL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/14/2022
Last updated
07/10/2023
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