Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | 016-004694 | IL |
NPI | 1063417921 |
---|---|
Provider Name | Dr. William R. Storino |
First Address | Grayslake, IL 60030-2076 |
Second Address | Grayslake, IL 60030-2076 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2005 |
Last Update Date | 20/02/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
016004694 | (05) | IL |
016-05176 | BLUE CROSS BLUE SHIELD (01) | IL |
3418679001 | CIGNA (01) | IL |
480030836 | MEDICARE RAILROAD (01) | IL |
5409760001 | DMEPOS (01) | IL |
9053889 | PCHS (01) | IL |
U47427 | (02) | IL |