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1912169764
TIM S. PROVIAS
CHICAGO, IL
NPI
1912169764
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
207RI0011X Internal Medicine, Interventional Cardiology
(Licence: IL 036129441)
Enumeration Date
2008-07-01
Last Update Date
2015-03-25
Business Address
-- TIM S. PROVIAS M.D.
675 N SAINT CLAIR ST GALTER 19-100
CHICAGO, IL 60611-5975
Phone number: 312-695-2458
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Mailing Address
-- TIM S. PROVIAS M.D.
680 N LAKE SHORE DR SUITE 1000
CHICAGO, IL 60611-4546
Phone number: 312-695-2458
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