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General NPI Number Information
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NPI Number | 1306108139
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Entity Type | Individual
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Provider Name | ALISSA DANIELLE DRIES M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/07/2012
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Last Update Date | 06/16/2012
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Provider Practice Location Address
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Address Line | 1653 W CONGRESS PKWY SUITE 720 PAVILLION
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City | CHICAGO
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State | IL
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Zip | 60612-3833
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Country | US
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Telephone | 312-942-6610
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Fax | 312-942-6606
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Provider Business Mailing Address
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Address Line | 2334 N SOUTHPORT AVE UNIT 2R
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City | CHICAGO
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State | IL
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Zip | 60614-8355
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Country | US
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Telephone | 262-391-7039
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 125061467
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License Number State | IL
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