Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 036124537 | IL |
Y | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | 036124537 | IL |
NPI | 1760718548 |
---|---|
Provider Name | Dr. Kelly Ed Jirschele |
First Address | Park Ridge, IL 60068-1168 |
Second Address | Park Ridge, IL 60068 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/10/2009 |
Last Update Date | 08/08/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036124537 | (05) | IL |