Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RE0101X | Endocrinologist (Diabetes Doctor) | 036050787 | IL |
N | 207RG0300X | Geriatric Medicine | 036050787 | IL |
NPI | 1023253531 |
---|---|
Provider Name | Dr. Stuart A Fine |
First Address | Chicago, IL 60611-2798 |
Second Address | Chicago, IL 60611-2798 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/12/2008 |
Last Update Date | 16/09/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
488151 | MEDICARE PROVIDER (01) | IL |
D13013 | (02) | IL |