Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 038-010245 | IL |
NPI | 1124193966 |
---|---|
Provider Name | Dimitry Likterev |
First Address | Buffalo Grove, IL 60089-4901 |
Second Address | Arlington Heights, IL 60004-3976 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/11/2006 |
Last Update Date | 13/07/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
V02315 | (02) | IL |