Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0000X | Obstetrician | 036116173 | IL |
NPI | 1386842300 |
---|---|
Provider Name | Dr. Lisa Memmel |
First Address | Evergreen Park, IL 60805-2701 |
Second Address | Chicago, IL 60652-3831 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2007 |
Last Update Date | 11/07/2007 |