Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 135.000908 | IL |
Y | 222Z00000X | Podiatrist | 135.000908 | IL |
NPI | 1013367671 |
---|---|
Provider Name | Geoffrey Mcallister |
First Address | Chicago, IL 60640-5759 |
Second Address | Chicago, IL 60640-5759 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2016 |
Last Update Date | 20/09/2016 |