Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0201X | Pediatric Allergist | 36062148 | IL |
NPI | 1750355087 |
---|---|
Provider Name | Annick Gaye |
First Address | Maywood, IL 60153 |
Second Address | Maywood, IL 60153 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/02/2006 |
Last Update Date | 15/09/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
369062148 | (05) | IL |
C39101 | (02) |