Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0207X | Pediatric Hematology-Oncologist | 036.153434 | IL |
NPI | 1053738518 |
---|---|
Provider Name | Chelsea Self |
First Address | Chicago, IL 60611-2991 |
Second Address | Chicago, IL 60611-2909 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2014 |
Last Update Date | 27/07/2020 |