Medical school: MIDWESTERN UNIVERSITY, CHICAGO COLLEGE OF OSTEOPATHIC MED
Graduated: 1991
NPI: 1427144310
Practice Locations (1)
PROVIDEA HEALTH PARTNERS LLC
9730 S WESTERN AVE, SUITE 700
EVERGREEN PARK, IL 608052814
7084251907
Source: CMS National Downloadable File, September 2026.