Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204C00000X | Sports Medicine Doctor | 181.000408 | IL |
NPI | 1265186720 |
---|---|
Provider Name | Dr. Antoaneta L. Condurat |
First Address | Skokie, IL 60076-3419 |
Second Address | Lincolnwood, IL 60712-3634 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/02/2022 |
Last Update Date | 10/02/2022 |