Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0120X | Pediatric Surgery | 036.131065 | IL |
N | 2086S0120X | Pediatric Surgery | MD037127 | DC |
NPI | 1417198318 |
---|---|
Provider Name | Dr. Mark Slidell |
First Address | Chicago, IL 60637-1447 |
Second Address | Chicago, IL 60637-1447 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2009 |
Last Update Date | 10/10/2012 |