Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 125.071734 | IL |
NPI | 1013400969 |
---|---|
Provider Name | Laura Anna Petrauskas |
First Address | Burr Ridge, IL 60527-6686 |
Second Address | Chicago, IL 60637-1443 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2018 |
Last Update Date | 14/06/2018 |