Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0117X | Orthopaedic Spine Surgeon | 036.155746 | IL |
NPI | 1164819207 |
---|---|
Provider Name | Gideon Blumstein |
First Address | Los Angeles, CA 90095-3075 |
Second Address | Chicago, IL 60612-4861 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/04/2015 |
Last Update Date | 28/07/2021 |