Doctor Name: | SEEMA R MAMTORA |
NPI Number: | 1043509607 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PAC |
License Number: | 085004008 |
Business Practice Address: | 17495 La Grange Rd Tinley Park, IL - 604877581 |
Business Phone Number: | 7082267000 |
Business Fax Number: | 7083885672 |
Mailing Address: | 2320 High St, BLUE ISLAND |
State: | IL |
Postal Code: | 604062426 |
Phone Number: | 7083885500 |
Fax Number: | 7083885672 |
NPI Enumeration Date: | 04/05/2011 |
NPI Last Update Date: | 04/05/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | 085004008 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |