Individual
JONNELLE CARMELITA SWEETNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
500 EAST 51ST STREET, CHICAGO, IL 60615-2400
(312) 572-1200
Mailing address
1622 ZEPHYR CT, MUNSTER, IN 46321-5103
(219) 922-2790
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
01044215A
IN
207R00000X
Internal Medicine Physician
Primary
036089953
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
036089953
STATE LICENSE
IL
05
—
200907200
—
IN
Enumeration date
08/10/2006
Last updated
10/01/2008
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