Graduated: 2012
NPI: 1336480102
Practice Locations (6)
2045 W GRAND AVE, SUITE B 28354
Chicago, IL 606121577
2045 W GRAND AVE, SUITE B 28354
CHICAGO, IL 606121577
15 GRUMMAN RD W, SUITE 1400
BETHPAGE, NY 117145029
ATTN MINUTECLINIC CREDENTIALING, 2100 1 CVS DR
WOONSOCKET, RI 028956146
MINUTECLINIC CREDENTIALING, PO BOX 772
WOONSOCKET, RI 028956146
PO BOX 772 - MC
WOONSOCKET, RI 028950784
Source: CMS National Downloadable File, September 2026.