Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | 036062531 | IL |
NPI | 1013995232 |
---|---|
Provider Name | Dr. Irene M Bakos |
First Address | Elmwood Park, IL 60707-4116 |
Second Address | Elmwood Park, IL 60707-4116 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/01/2006 |
Last Update Date | 27/12/2019 |