Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204E00000X | Oral & Maxillofacial Surgeon | PENDING | IL |
NPI | 1417418203 |
---|---|
Provider Name | Frank Rizzo |
First Address | Louisville, KY 40204-2031 |
Second Address | Maywood, IL 60153-3328 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/03/2019 |
Last Update Date | 10/06/2019 |