Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 021002075 | IL |
NPI | 1093943417 |
---|---|
Provider Name | Dr. Michele Karen Sackheim |
First Address | Bolingbrook, IL 60440-2014 |
Second Address | Bolingbrook, IL 60440-2014 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2009 |
Last Update Date | 19/08/2013 |