Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 021002897 | IL |
NPI | 1063894863 |
---|---|
Provider Name | Hussein Sahib |
First Address | Lake In The Hills, IL 60156-9797 |
Second Address | Lake In The Hills, IL 60156-9797 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2015 |
Last Update Date | 29/12/2020 |