Individual
SUPERMAN DAVID BERROW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MS, ATC, CES
Contact information
Practice address
1920 N FOOTBALL DR, HALAS HALL, LAKEFOREST, IL 60045
(847) 528-1234
Mailing address
2712 W NORTH AVE APT 2F, CHICAGO, IL 60647-5237
(859) 489-7645
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
096003014
IL
Other
Enumeration date
05/21/2014
Last updated
05/21/2014
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