Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223S0112X | Oral and Maxillofacial Surgeon | 021001736 | IL |
Y | 204E00000X | Oral & Maxillofacial Surgeon | 019-022323 | IL |
NPI | 1548283492 |
---|---|
Provider Name | Dr. Julie Laverdiere Beck |
First Address | Glenview, IL 60026 |
Second Address | Glenview, IL 60026 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2006 |
Last Update Date | 26/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U58262 | (02) |