Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | IL |
NPI | 1063403665 |
---|---|
Provider Name | Dr. Joel N Slutsky |
First Address | Kankakee, IL 60901-3483 |
Second Address | Kankakee, IL 60901-3483 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2005 |
Last Update Date | 27/01/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4600208 | BLUE CROSS BLUE SHIELD (01) | IL |
C44840 | (02) | IL |
L15643 | (02) | IL |
L28009 | (02) | IL |
L53752 | (02) | IL |