Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | 016-003013 | IL |
NPI | 1023027687 |
---|---|
Provider Name | Dr. Joel F Spatt |
First Address | Buffalo Grove, IL 60089-1038 |
Second Address | Long Grove, IL 60047-9583 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
60201266 | BLUE CROSS BLUE SHIELD (01) | IL |
T36968 | (02) | IL |