Individual
AMANDA E LOOMIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CTRS
Contact information
Practice address
2211 N OAK PARK AVE, CHICAGO, IL 60707-3351
(773) 385-5515
(773) 385-5453
Mailing address
2211 N OAK PARK AVE, CHICAGO, IL 60707-3351
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
57710
IL
Other
Enumeration date
06/06/2011
Last updated
06/06/2011
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