Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 019.027365 | IL |
NPI | 1003011826 |
---|---|
Provider Name | Bilus D Poles |
First Address | Des Plaines, IL 60016-1656 |
Second Address | Chicago, IL 60640-5255 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2007 |
Last Update Date | 08/07/2007 |