Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 036-082052 | IL |
NPI | 1174695878 |
---|---|
Provider Name | Dr. Warren S Jablonsky |
First Address | Crystal Lake, IL 60012-3709 |
Second Address | Crystal Lake, IL 60012 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/11/2006 |
Last Update Date | 07/06/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036082052 | (05) | IL |
036082052 | STATE LICENSE (01) | IL |
F75387 | (02) |