Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2080P0205X | Pediatric Endocrinologist | 036118039 | IL |
Y | 2080P0205X | Pediatric Endocrinologist | MD422160 | PA |
NPI | 1063455699 |
---|---|
Provider Name | Diego Ize-Ludlow |
First Address | Chicago, IL 60612-4325 |
Second Address | Chicago, IL 60612-4325 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2006 |
Last Update Date | 05/12/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I72196 | (02) | PA |