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1104200625
ALYSSA BRIE KETCHUM
CHICAGO, IL
NPI
1104200625
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Former Name
ALYSSA BRIE TEASDALE
Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
363AS0400X Physician Assistant, Surgical
(Licence: IL 085005549)
Enumeration Date
2015-07-14
Last Update Date
2018-12-17
Business Address
ALYSSA BRIE KETCHUM PA-C
676 N SAINT CLAIR ST STE 1900
CHICAGO, IL 60611-2986
Phone number: 312-926-5354
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Mailing Address
ALYSSA BRIE KETCHUM PA-C
676 N SAINT CLAIR ST STE 1900
CHICAGO, IL 60611-2986
Phone number: 312-926-5354
Copy
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