Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 036146924 | IL |
N | 207QG0300X | Family Doctor - Geriatric Medicine | 036146924 | IL |
NPI | 1093102758 |
---|---|
Provider Name | Dr. Monica Shalise' Buckner |
First Address | Chicago, IL 60615-3428 |
Second Address | Chicago, IL 60616-4108 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/04/2015 |
Last Update Date | 01/08/2019 |