Individual
GE LI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD, PH.D.
Contact information
Practice address
2160 S 1ST AVE, MAYWOOD, IL 60153-3328
(708) 216-9000
Mailing address
PO BOX 443, BEDFORD PARK, IL 60499-0443
(708) 831-8282
(773) 714-1229
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
036110552
IL
207L00000X
Anesthesiology Physician
A90041
CA
Other
Enumeration date
08/21/2006
Last updated
12/08/2022
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