Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 036129710 | IL |
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 036129710 | IL |
NPI | 1376747188 |
---|---|
Provider Name | Dr. Junaid Makda |
First Address | Lincolnshire, IL 60069-3095 |
Second Address | Lincolnshire, IL 60069-3095 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2007 |
Last Update Date | 11/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
209398 | MEDICARE GROUP PTAN (01) |