Individual
KAYLA ANN COUNCELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5841 S MARYLAND AVE # 6040, CHICAGO, IL 60637-1443
(773) 702-2500
Mailing address
180 HARVESTER DR STE 110, BURR RIDGE, IL 60527-6686
(773) 702-1150
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
125.075710
IL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/17/2020
Last updated
06/20/2024
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