Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | IL |
NPI | 1013004282 |
---|---|
Provider Name | Dr. Ralph Solomon |
First Address | Willow Springs, IL 60480-1802 |
Second Address | Chicago, IL 60615-2400 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E 93362 | (02) | IL |