Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080N0001X | Neonatal-Perinatal Doctor | 036-106562 | IL |
N | 2080N0001X | Neonatal-Perinatal Doctor | 48209-020 | WI |
NPI | 1023121662 |
---|---|
Provider Name | Dr. Duane David Stich |
First Address | Park Ridge, IL 60068-1143 |
Second Address | Park Ridge, IL 60068-1143 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2006 |
Last Update Date | 14/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036-106562 | (05) | IL |
34658700 | (05) | WI |
K21399 | (02) |