Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0400X | Neurologist | 036068442 | IL |
NPI | 1033510615 |
---|---|
Provider Name | Eduard Obolsky |
First Address | Winnetka, IL 60093-2559 |
Second Address | Winnetka, IL 60093-2559 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/09/2014 |
Last Update Date | 15/09/2014 |