Facts
- Status
- A
- Credential
- Surgical assistant
- Type
- Individual
- Enumeration date
- 2016-08-08
- Last updated
- 2016-08-08
Licenses
- License WI
- 16-393
Location
- Practice location
- 1526 W PLAINFIELD RD
- City
- LA GRANGE HIGHLANDS IL
- Postal code
- 605257020
- Phone
- 630-504-9136
Medicare
- PECOS
- No PECOS enrollment row matched this NPI.
LEIE
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Nearby
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.