Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YP0228X | Pediatric Otolaryngology | 125 | IL |
NPI | 1750671814 |
---|---|
Provider Name | Jill D'souza |
First Address | Chicago, IL 60654-8805 |
Second Address | The Woodlands, TX 77384 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/04/2011 |
Last Update Date | 17/03/2018 |