Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 036130558 | IL |
Y | 111NI0900X | Internist | 036130558 | IL |
NPI | 1003057936 |
---|---|
Provider Name | Dr. Kristi A Tough Desapri |
First Address | Chicago, IL 60611-3926 |
Second Address | Chicago, IL 60611 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/03/2009 |
Last Update Date | 03/06/2019 |