Individual
DANA BRANCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1 INGALLS DR, HARVEY, IL 60426-3558
(708) 333-2300
Mailing address
355 E ERIE ST, CHICAGO, IL 60611-3167
(312) 238-1000
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
036-153000
IL
390200000X
Student in an Organized Health Care Education/Training Program
B71711527359902
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036153000-1
—
IL
Enumeration date
04/14/2016
Last updated
11/04/2020
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