Healthcare Provider Details

I. General information

NPI: 1851185185
Provider Name (Legal Business Name): ALLISON MONIE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2025
Last Update Date: 06/24/2025
Certification Date: 06/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3134 N CLARK ST
CHICAGO IL
60657-4414
US

IV. Provider business mailing address

3134 N CLARK ST
CHICAGO IL
60657-4414
US

V. Phone/Fax

Practice location:
  • Phone: 312-766-4949
  • Fax: 312-766-4925
Mailing address:
  • Phone: 312-766-4949
  • Fax: 312-766-4925

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number125.086853
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: