Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2082S0105X | Plastic Hand Surgeon | 036.043700 | IL |
NPI | 1326305632 |
---|---|
Provider Name | Dr. Jack Michael Monasterio |
First Address | Winfield, IL 60190 |
Second Address | Winfield, IL 60190-2313 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/04/2012 |
Last Update Date | 12/04/2012 |