Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | 036-102370 | IL |
NPI | 1285662304 |
---|---|
Provider Name | Dr. Brian Rotskoff |
First Address | Chicago, IL 60646-5713 |
Second Address | Chicago, IL 60646-5713 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2006 |
Last Update Date | 10/06/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H36114 | (02) | IL |
K49734 | (02) | IL |