Individual
COLLEEN D FANT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD, MPH
Contact information
Practice address
225 E CHICAGO AVE, CHICAGO, IL 60611-2991
(800) 543-7362
Mailing address
ANN & ROBERT H LURIE CHILDREN'S HOSPITAL, 225 EAST CHICAGO AVE, CHICAGO, IL 60611-2991
(800) 543-7365
Taxonomy
Speciality
Code
Description
License number
State
207PP0204X
Pediatric Emergency Medicine (Emergency Medicine) Physician
Primary
036140292
IL
208000000X
Pediatrics Physician
036140292
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036140292
—
IL
Enumeration date
05/29/2013
Last updated
10/04/2019
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