Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | C1-0024073 | DE |
N | 207XS0106X | Orthopaedic Hand Surgeon | 125069742 | IL |
Y | 207XS0106X | Orthopaedic Hand Surgeon | C1-0024073 | DE |
NPI | 1235491069 |
---|---|
Provider Name | Dr. Grigory E Gershkovich |
First Address | Burr Ridge, IL 60527-6686 |
Second Address | Chicago, IL 60637-1447 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2012 |
Last Update Date | 08/11/2021 |