Provider Demographics
NPI:1790811545
Name:BILL, EFSTATHIA MARIA (LAC)
Entity Type:Individual
Prefix:
First Name:EFSTATHIA
Middle Name:MARIA
Last Name:BILL
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:
Other - Last Name:BILL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LAC
Mailing Address - Street 1:13144 S BUFFALO AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60633-1327
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13144 S BUFFALO AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60633-1327
Practice Address - Country:US
Practice Address - Phone:312-241-0027
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL198.001125171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist