Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204E00000X | Oral & Maxillofacial Surgeon | 019.033170 | IL |
NPI | 1194393140 |
---|---|
Provider Name | Dr. Daniel Setzke |
First Address | Glen Ellyn, IL 60137-4013 |
Second Address | Urbana, IL 61801-2529 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2021 |
Last Update Date | 16/06/2021 |