Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 36042189 | IL |
NPI | 1003888389 |
---|---|
Provider Name | Dr. Michael R Treister |
First Address | Chicago, IL 60622-1797 |
Second Address | Chicago, IL 60622-1797 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/02/2006 |
Last Update Date | 14/03/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036042189 | (05) | IL |
C38502 | (02) | IL |