Individual
MARIANNE GOULD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1501 S CALIFORNIA AVE, CHICAGO, IL 60608-1732
(773) 257-6770
Mailing address
1501 S CALIFORNIA AVE, CHICAGO, IL 60608-1732
(773) 257-6770
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085-002015
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
085-002015
STATE LICENSE
IL
Enumeration date
05/11/2006
Last updated
10/07/2008
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