Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 036-111652 | IL |
NPI | 1255329470 |
---|---|
Provider Name | Dr. Ari B Rubenfeld |
First Address | Chicago, IL 60612-7242 |
Second Address | Chicago, IL 60612-7242 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2005 |
Last Update Date | 06/05/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036-111652-1 | (05) | IL |
I17276 | (02) | IL |