Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RR0500X | Rheumatology | 036138068 | IL |
NPI | 1033467196 |
---|---|
Provider Name | Jacquelin Ratunil Chua |
First Address | Chicago, IL 60612-4861 |
Second Address | Montgomery, AL 36106 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/08/2012 |
Last Update Date | 21/06/2018 |