Individual
THOR JALECO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHYSICIAN ASSISTANT
Contact information
Practice address
4025 N SHERIDAN RD, CHICAGO, IL 60613-2010
(773) 388-1600
Mailing address
4025 N SHERIDAN RD, CHICAGO, IL 60613-2010
(773) 388-1600
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085.011190
IL
Other
Enumeration date
05/12/2025
Last updated
05/12/2025
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