Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | 162862 | IL |
NPI | 1477626166 |
---|---|
Provider Name | Dr. Raymond Henry Hanzelin |
First Address | Burr Ridge, IL 60527-5948 |
Second Address | Lyons, IL 60534-1320 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/11/2006 |
Last Update Date | 16/12/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T36944 | (02) | IL |