Graduated: 1996
NPI: 1548388846
Practice Locations (3)
COOK COUNTY
1901 W HARRISON ST
CHICAGO, IL 606123714
3126337292
COOK COUNTY
500 E 51ST ST
CHICAGO, IL 606152494
3125722000
COOK COUNTY
5501 W FULLERTON AVE
CHICAGO, IL 606391368
3128640200
Source: CMS National Downloadable File, September 2026.