Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204E00000X | Oral & Maxillofacial Surgeon | 036138497 | IL |
N | 204E00000X | Oral & Maxillofacial Surgeon | 058934 | NY |
N | 204E00000X | Oral & Maxillofacial Surgeon | 286755 | NY |
NPI | 1225291347 |
---|---|
Provider Name | Dr. Michael Robert Markiewicz |
First Address | Chicago, IL 60612-7210 |
Second Address | Chicago, IL 60612-7210 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/07/2008 |
Last Update Date | 19/03/2019 |