Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 036099729 | IL |
NPI | 1003802091 |
---|---|
Provider Name | Duncan Dinkha |
First Address | Morton Grove, IL 60053-1322 |
Second Address | Morton Grove, IL 60053-1322 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/09/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H06506 | (02) | IL |