Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 36081662 | IL |
NPI | 1063451458 |
---|---|
Provider Name | Dr. Belmina Michael |
First Address | Elmwood Park, IL 60707-4109 |
Second Address | Forest Park, IL 60130-3100 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/06/2006 |
Last Update Date | 31/07/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036081662 | (05) | IL |
E49808 | (02) |