Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | 036132027 | IL |
NPI | 1912227463 |
---|---|
Provider Name | Dr. Tanaka Junior Dune |
First Address | Maywood, IL 60153 |
Second Address | Maywood, IL 60153 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2010 |
Last Update Date | 12/07/2013 |