Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 136000222 | IL |
NPI | 1013414655 |
---|---|
Provider Name | Flavio Jose Castelli Sanchez |
First Address | Chicago, IL 60607-2572 |
Second Address | Chicago, IL 60612-7210 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2018 |
Last Update Date | 10/04/2018 |