Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | 125.078176 | IL |
NPI | 1003492026 |
---|---|
Provider Name | Curtis James Heisel |
First Address | Chicago, IL 60611-3055 |
Second Address | Chicago, IL 60611-3055 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/03/2021 |
Last Update Date | 08/06/2021 |