Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 036100443 | IL |
Y | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | 036-100443 | IL |
NPI | 1366432338 |
---|---|
Provider Name | Jeffery A Senall |
First Address | Warrenville, IL 60555-3845 |
Second Address | Warrenville, IL 60555-3845 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/10/2005 |
Last Update Date | 06/02/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036100443 | (05) | IL |
206147 | MEDICARE PTAN (GROUP) (01) | IL |
G68243 | (02) | IL |
P01136351 | RR MEDICARE (01) | IL |