Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204E00000X | Oral & Maxillofacial Surgeon | IL |
NPI | 1114025574 |
---|---|
Provider Name | Dr. Michael John Karakourtis |
First Address | Naperville, IL 60540-6595 |
Second Address | Naperville, IL 60540-6595 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T36216 | (02) |