Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 01062695A | IN |
NPI | 1043230345 |
---|---|
Provider Name | Dr. Dmitry Novoseletsky |
First Address | Bartlett, IL 60103-3007 |
Second Address | Bartlett, IL 60103-3007 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2006 |
Last Update Date | 25/01/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200858900 | (05) | IN |