Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | 036-056023 | IL |
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 036-056023 | IL |
NPI | 1043205248 |
---|---|
Provider Name | James L Greco |
First Address | Berwyn, IL 60402-1007 |
Second Address | Berwyn, IL 60402-1007 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/09/2005 |
Last Update Date | 05/02/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D14513 | (02) | IL |