Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 036094484 | IL |
Y | 207XS0106X | Orthopaedic Hand Surgeon | 036094484 | IL |
NPI | 1043274962 |
---|---|
Provider Name | Alfonso Mejia |
First Address | Skokie, IL 60076-1214 |
Second Address | Skokie, IL 60076-1214 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2006 |
Last Update Date | 16/10/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G46586 | (02) | IL |