Individual
ELLAWEASE EARLS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
8801 S CONSTANCE AVE, CHICAGO, IL 60617-2955
(773) 206-2468
(773) 382-0333
Mailing address
8801 S CONSTANCE AVE, CHICAGO, IL 60617-2955
(773) 206-2468
(773) 382-0333
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
Other
Enumeration date
10/17/2014
Last updated
10/17/2014
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