Healthcare Provider Details

I. General information

NPI: 1013980507
Provider Name (Legal Business Name): LAEH ESTHER LITIN RD, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2006
Last Update Date: 03/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3633 N CALIFORNIA AVE
CHICAGO IL
60618-4602
US

IV. Provider business mailing address

6433 N WASHTENAW AVE APT 1
CHICAGO IL
60645-5305
US

V. Phone/Fax

Practice location:
  • Phone: 773-539-3600
  • Fax: 773-539-9158
Mailing address:
  • Phone: 773-338-0914
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number096-000761
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: