Individual
DR. LISA C. MAZZULLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
737 N MICHIGAN AVE, SUITE 950, CHICAGO, IL 60611-2615
(312) 751-7515
(312) 751-1208
Mailing address
55 W DELAWARE PL, UNIT 907, CHICAGO, IL 60610-3360
(312) 751-7515
(312) 751-1208
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
IL
Other
Enumeration date
05/18/2006
Last updated
07/08/2007
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