Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 016.005601 | IL |
Y | 222Z00000X | Podiatrist | 016.005601 | IL |
NPI | 1053609248 |
---|---|
Provider Name | David Benjamin Gelbmann |
First Address | Vernon Hills, IL 60061-1564 |
Second Address | Chicago, IL 60622-5512 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2011 |
Last Update Date | 25/08/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F400141158 | MEDICARE PTAN (01) | IL |