Individual
MRS. MATT WINDHAM JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2056 E 71ST ST, CHICAGO, IL 60649-2117
(773) 288-2844
(773) 288-2848
Mailing address
2056 E 71ST ST, CHICAGO, IL 60649-2117
(773) 288-2844
(773) 288-2848
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
V797P-4898A
NATIONAL ACQUISTION VA
IL
Enumeration date
09/26/2006
Last updated
07/08/2007
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