Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0001X | Clinical Cardiac Electrophysiologist | 036103567 | IL |
NPI | 1093712481 |
---|---|
Provider Name | Erica D Engelstein |
First Address | Chicago, IL 60631-3713 |
Second Address | Chicago, IL 60631-3713 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2005 |
Last Update Date | 22/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036103567 | (05) | IL |
G17177 | (02) | IL |