Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207K00000X | Allergist & Immunologist | 036083285 | IL |
Y | 207RA0201X | Internist - Allergy & Immunology | 036083285 | IL |
NPI | 1477553899 |
---|---|
Provider Name | Dr. Miguel Jaen Alcordo |
First Address | Orland Park, IL 60467-5857 |
Second Address | Tinley Park, IL 60487-7722 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2005 |
Last Update Date | 17/10/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F36152 | (02) |