Individual
PATRICIA A LARSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
901 BIESTERFIELD RD STE 213, ELK GROVE VILLAGE, IL 60007
(847) 690-9767
Mailing address
PO BOX 529, ITASCA, IL 60143-0529
(847) 981-9699
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
036050093
IL
207RI0200X
Infectious Disease Physician
Primary
036050093
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01633976
BC/BS
—
01
—
212087
GROUP MEDICARE
—
Enumeration date
07/18/2006
Last updated
07/02/2018
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