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ProviderCode | Provider Name | Physician ID | Last Name | First Name | Middle Name | TIN # | Specialization | Sub Specialization |
|---|---|---|---|---|---|---|---|---|
'001714 | ACTIVELIFE CHICAGO PHYSICAL THERAPY CLINIC - MALOLOS | '030197 | URSUS | DORIA | R | Internal Medicine | ||
'001714 | ACTIVELIFE CHICAGO PHYSICAL THERAPY CLINIC - MALOLOS | '020639 | UDAUNDO | RALPH JAYSON | CALIMAG | 318984490 | Internal Medicine |
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