Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213EP1101X | Primary Podiatric Medicine | 016005491 | IL |
Y | 213ES0103X | Foot & Ankle Surgery | 016005491 | IL |
NPI | 1255684635 |
---|---|
Provider Name | Dr. Yelena Boumendjel |
First Address | Oak Lawn, IL 60453-1836 |
Second Address | Oak Lawn, IL 60453-1836 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/10/2012 |
Last Update Date | 18/12/2021 |