Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 036.154011 | IL |
NPI | 1003308255 |
---|---|
Provider Name | Adem Shuaipaj |
First Address | Chicago, IL 60674-0018 |
Second Address | Oak Lawn, IL 60453-2611 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/06/2018 |
Last Update Date | 03/08/2021 |