Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 036-090163 | IL |
NPI | 1023054954 |
---|---|
Provider Name | Dr. Alexandria Z Meccia |
First Address | Burr Ridge, IL 60527-5159 |
Second Address | Berwyn, IL 60402-3073 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2006 |
Last Update Date | 03/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G10805 | (02) | IL |