Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 036-105713 | IL |
NPI | 1003864539 |
---|---|
Provider Name | Dr. Daniel A Ivankovich |
First Address | Glenview, IL 60025-1774 |
Second Address | Chicago, IL 60622-2743 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/05/2006 |
Last Update Date | 26/04/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036105713 | (05) | IL |