Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207ND0900X | Dermatopathologist | 2086S0122X | IL |
NPI | 1467476457 |
---|---|
Provider Name | Dr. Jeffrey Berti |
First Address | Willowbrook, IL 60527-5154 |
Second Address | Willowbrook, IL 60527-5154 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G18909 | (02) | IL |