Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 036065095 | IL |
N | 207ND0101X | MOHS-Micrographic Surgeon | 036065095 | IL |
N | 207NP0225X | Pediatric Dermatologist | 036065095 | IL |
N | 207NS0135X | Procedural Dermatology | 036065095 | IL |
NPI | 1114936077 |
---|---|
Provider Name | Dr. Paul A Storrs |
First Address | Chicago, IL 60611-3427 |
Second Address | Chicago, IL 60612-7232 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/08/2006 |
Last Update Date | 26/09/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C48891 | (02) | IL |