Individual
GODA ORENTAITE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
9760 S KEDZIE AVE STE 3, EVERGREEN PARK, IL 60805-3184
(708) 423-6209
Mailing address
9760 S KEDZIE AVE STE 3, EVERGREEN PARK, IL 60805-3184
(708) 423-6209
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
09/13/2022
Last updated
09/19/2022
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