Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 19A13824 | IL |
NPI | 1013013614 |
---|---|
Provider Name | Dr. Stuart Lee Goldblatt |
First Address | Buffalo Grove, IL 60089-6680 |
Second Address | Chicago, IL 60656-2161 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/09/2006 |
Last Update Date | 08/07/2007 |