Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | 036.153527 | IL |
Y | 213ES0000X | Sports Medicine | 036.153527 | IL |
NPI | 1366806119 |
---|---|
Provider Name | Andrea Kelley Cyr |
First Address | Chicago, IL 60608-1530 |
Second Address | Chicago, IL 60608-1530 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/04/2016 |
Last Update Date | 13/10/2021 |