Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 019030046 | IL |
N | 204E00000X | Oral & Maxillofacial Surgeon | 018001868 | IL |
NPI | 1114365780 |
---|---|
Provider Name | Dr. Philip W Meehan |
First Address | Chicago, IL 60612-3714 |
Second Address | Chicago, IL 60612-3714 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2013 |
Last Update Date | 26/05/2016 |