Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | IL |
NPI | 1013076157 |
---|---|
Provider Name | Florida Dy |
First Address | Lake Bluff, IL 60044-2203 |
Second Address | Arlington Heights, IL 60005-2349 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/12/2006 |
Last Update Date | 17/10/2007 |