Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | 036.155056 | IL |
NPI | 1013361823 |
---|---|
Provider Name | Derek Klavas |
First Address | Chicago, IL 60612-3828 |
Second Address | Chicago, IL 60612-3828 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/04/2016 |
Last Update Date | 28/06/2021 |