Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 019024403 | IL |
NPI | 1003148891 |
---|---|
Provider Name | Dr. Mark S Palo |
First Address | Oak Brook, IL 60523-1806 |
Second Address | Oak Brook, IL 60523-1806 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/02/2010 |
Last Update Date | 04/02/2010 |