Individual
JACKIE TA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O
Contact information
Practice address
1653 W CONGRESS PKWY, CHICAGO, IL 60612-3833
(703) 342-9546
Mailing address
1653 W CONGRESS PKWY, CHICAGO, IL 60612-3833
(703) 342-9546
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
125067630
IL
Other
Enumeration date
06/20/2015
Last updated
06/20/2015
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