Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | IL | |
N | 111NN0400X | Neurology | 4121012 | WI |
NPI | 1669546313 |
---|---|
Provider Name | Dr. Carlos Halwaji |
First Address | Chicago, IL 60623-4037 |
Second Address | Chicago, IL 60623-4037 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/11/2006 |
Last Update Date | 08/07/2007 |