Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 036125755 | IL |
N | 207VX0000X | Obstetrician | 4301083889 | MI |
NPI | 1407065154 |
---|---|
Provider Name | Eiman El Tag |
First Address | Evanston, IL 60201-1700 |
Second Address | Worth, IL 60482-2060 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/05/2007 |
Last Update Date | 08/10/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036125755 | MEDICAL LICENSE (01) | IL |