Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | 5901002505 | MI |
N | 213ES0103X | Foot & Ankle Surgery | 016005811 | IL |
N | 213ES0103X | Foot & Ankle Surgery | 5901002505 | MI |
NPI | 1558703298 |
---|---|
Provider Name | Audey Nasser |
First Address | Grayslake, IL 60030-2015 |
Second Address | Grayslake, IL 60030-2015 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/07/2013 |
Last Update Date | 12/12/2021 |