Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 036145635 | IL |
N | 207YS0123X | Facial Plastic Surgeon | 036.145635 | IL |
NPI | 1417213257 |
---|---|
Provider Name | Dr. Julia Lynn Kerolus |
First Address | Chicago, IL 60612-7242 |
Second Address | Chicago, IL 60612-7232 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/04/2012 |
Last Update Date | 23/06/2020 |