Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080N0001X | Neonatal-Perinatal Doctor | 036076574 | IL |
NPI | 1043221302 |
---|---|
Provider Name | Jeffrey A George |
First Address | Park Ridge, IL 60068-1143 |
Second Address | Park Ridge, IL 60068-1143 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2006 |
Last Update Date | 28/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036076574 | (05) | IL |
H18074 | (02) | IL |