Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | 036080243 | IL |
N | 207VG0400X | Gynecologist | 036080243 | IL |
NPI | 1073597894 |
---|---|
Provider Name | Dr. Marko J Jachtorowycz |
First Address | Morton Grove, IL 60053-3056 |
Second Address | Morton Grove, IL 60053-3056 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/12/2005 |
Last Update Date | 15/11/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036080243 | (05) | IL |
F28788 | (02) | IL |