Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | 036081009 | IL |
N | 207VG0400X | Gynecologist | 036081009 | IL |
NPI | 1821087669 |
---|---|
Provider Name | Dr. Denise M Poulos |
First Address | Oak Lawn, IL 60453-2362 |
Second Address | Oak Lawn, IL 60453-2362 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/10/2005 |
Last Update Date | 04/02/2022 |