Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 019-0016706 | IL |
N | 1223P0300X | Periodontist | 021-1093 | IL |
NPI | 1114044526 |
---|---|
Provider Name | Dr. Michelle N Zmick |
First Address | Long Grove, IL 60047-9794 |
Second Address | Long Grove, IL 60047-9794 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2007 |
Last Update Date | 08/07/2007 |