Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 036.132972 | IL |
N | 207N00000X | Dermatologist | 242826 | MA |
NPI | 1013105444 |
---|---|
Provider Name | Dr. James A Ida JR. |
First Address | Chicago, IL 60640-2701 |
Second Address | Chicago, IL 60640-2701 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/10/2007 |
Last Update Date | 20/04/2020 |