Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RX0202X | Medical Oncology | IL |
NPI | 1134101025 |
---|---|
Provider Name | Dr. Michael B Soble |
First Address | Libertyville, IL 60048-5263 |
Second Address | Barrington, IL 60010-2379 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/11/2005 |
Last Update Date | 29/01/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G92351 | (02) | IL |