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General NPI Number Information
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NPI Number | 1922413301
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Entity Type | Organization
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Legal Business Name | ALTRUIS MEDICAL LTD
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Dates
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Enumeration Date | 06/24/2014
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Last Update Date | 07/09/2014
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Provider Practice Location Address
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Address Line | 1016 W JACKSON BLVD
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City | CHICAGO
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State | IL
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Zip | 60607-2914
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Country | US
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Telephone | 872-216-5599
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Fax |
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Provider Business Mailing Address
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Address Line | 1016 W JACKSON BLVD
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City | CHICAGO
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State | IL
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Zip | 60607-2914
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ANDREW CHET
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Credential | D.O.
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Telephone | 872-216-5599
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 036133954
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License Number State | IL
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