Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | 036146476 | IL |
NPI | 1588084552 |
---|---|
Provider Name | Melissa Watts |
First Address | Chicago, IL 60611-2915 |
Second Address | Chicago, IL 60611-2915 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2014 |
Last Update Date | 28/10/2021 |