Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 036091945 | IL |
NPI | 1194897124 |
---|---|
Provider Name | Gregory G Markarian |
First Address | Naperville, IL 60540 |
Second Address | Naperville, IL 60540 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/11/2006 |
Last Update Date | 16/07/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
209734 | MEDICARE PTAN (01) | IL |
G56063 | (02) |