Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | 213000185 | IL |
N | 222Z00000X | Podiatrist | 213000185 | IL |
Y | 224P00000X | Prosthetist | 211000159 | IL |
NPI | 1194225227 |
---|---|
Provider Name | David B Rotter |
First Address | Joliet, IL 60435-6545 |
Second Address | Joliet, IL 60435-6545 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/02/2018 |
Last Update Date | 11/04/2019 |