Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | IL |
NPI | 1083763825 |
---|---|
Provider Name | Dr. James Edward Mccormick |
First Address | Palos Heights, IL 60463-1001 |
Second Address | Palos Heights, IL 60463-1001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/01/2007 |
Last Update Date | 08/07/2007 |