Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2084N0400X | Neurologist | 036-140005 | IL |
Y | 2084N0600X | Clinical Neurophysiologist | 036140005 | IL |
NPI | 1427311646 |
---|---|
Provider Name | Dr. Yara Mikhaeil-Demo |
First Address | Chicago, IL 60611 |
Second Address | Chicago, IL 60611-2908 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2012 |
Last Update Date | 07/10/2020 |