Individual
IBTISAM CHOUDHURY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3333 GREEN BAY ROAD, NOTH CHICAGO, IL 60085
(847) 578-3000
Mailing address
332 N GREEN BAY RD APT 1608, WAUKEGAN, IL 60085-4469
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
125064215
IL
Other
Enumeration date
06/19/2014
Last updated
06/19/2014
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