Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 036132746 | IL |
N | 208800000X | Urologist | 2011-01423 | NC |
NPI | 1033377403 |
---|---|
Provider Name | Dr. Michael Ryan Abern |
First Address | Chicago, IL 60612-4325 |
Second Address | Chicago, IL 60612-4325 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2008 |
Last Update Date | 12/08/2013 |