Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 016003880 | IL |
Y | 222Z00000X | Podiatrist | 016003880 | IL |
N | 213ES0103X | Foot & Ankle Surgery | 016003880 | IL |
NPI | 1073680203 |
---|---|
Provider Name | George L Enriquez SR. |
First Address | Mt Prospect, IL 60056-6023 |
Second Address | Bannockburn, IL 60015-1836 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/11/2006 |
Last Update Date | 30/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
016003880 | (05) | IL |
T38581 | (02) | IL |