Individual
MAURICE PUOMAAYE KONTA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
7220 S SOUTH SHORE DR APT 406, CHICAGO, IL 60649-2751
(872) 901-2057
Mailing address
7220 S SOUTH SHORE DR APT 406, CHICAGO, IL 60649-2751
(312) 774-5315
Taxonomy
Speciality
Code
Description
License number
State
163WA2000X
Administrator Registered Nurse
Primary
041399052
IL
Other
Enumeration date
04/02/2024
Last updated
04/02/2024
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