Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RX0202X | Medical Oncology | 0101261271 | VA |
N | 207RX0202X | Medical Oncology | 036-109601 | IL |
NPI | 1003851460 |
---|---|
Provider Name | Dr. Michael Maitland |
First Address | Chicago, IL 60610-7231 |
Second Address | Fairfax, VA 22031-4867 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/06/2006 |
Last Update Date | 16/10/2020 |