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1043424740
MARK AMBROSE
HAZEL CREST, IL
NPI
1043424740
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
363A00000X Physician Assistant
(Licence: IL 085000830)
Enumeration Date
2007-05-10
Last Update Date
2016-05-13
Business Address
-- MARK AMBROSE PA-C
3330 W 177TH ST SUITE 3E
HAZEL CREST, IL 60429-2184
Phone number: 708-206-0010
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Mailing Address
-- MARK AMBROSE PA-C
16450 104TH AVE STE 101
ORLAND PARK, IL 60467-5416
Phone number: 708-206-0010
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