Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223X0400X | Orthodontists | IL | |
Y | 1223X0400X | Orthodontists | IL |
NPI | 1073615449 |
---|---|
Provider Name | Dr. Lisa Diane Eckenstein |
First Address | Orland Park, IL 60467-8898 |
Second Address | Orland Park, IL 60467-8898 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/09/2006 |
Last Update Date | 08/07/2007 |