Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 036097420 | IL |
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 036097420 | IL |
NPI | 1205813813 |
---|---|
Provider Name | Dr. Steven A Marciniak |
First Address | Aurora, IL 60504-4511 |
Second Address | Aurora, IL 60504-7597 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/12/2005 |
Last Update Date | 29/05/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036097420 | (05) | IL |
H15596 | (02) | IL |