Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 125-067028 | IL |
Y | 207QS0010X | Family Doctor - Sports Medicine | 036146090 | IL |
NPI | 1093197220 |
---|---|
Provider Name | Anne Viollt |
First Address | Chicago, IL 60605-2741 |
Second Address | Chicago, IL 60605 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2015 |
Last Update Date | 27/06/2019 |