Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RN0300X | Nephrologist | 036099895 | IL |
NPI | 1073620936 |
---|---|
Provider Name | Dr. Marvin Sinsakul |
First Address | Chicago, IL 60607-1821 |
Second Address | Chicago, IL 60607-1821 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/08/2006 |
Last Update Date | 25/09/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01615381 | BC/BS ID NUMBER (01) | IL |
036099895 | (05) | IL |
390008272 | RAILROAD MEDICARE (01) | GA |
H40439 | (02) | IL |