Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | 135.001027 | IL |
NPI | 1003392655 |
---|---|
Provider Name | Amit Raj |
First Address | Chicago, IL 60613-3346 |
Second Address | Chicago, IL 60625-3687 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2018 |
Last Update Date | 17/07/2018 |