Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 019013177 | IL |
Y | 1223E0200X | Endodontist | 021000864 | IL |
NPI | 1043650658 |
---|---|
Provider Name | Dr. Ronald Marshall Milnarik |
First Address | Chicago, IL 60612-7210 |
Second Address | Chicago, IL 60612-7210 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2013 |
Last Update Date | 27/06/2013 |