Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 036144323 | IL |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 036144323 | IL |
NPI | 1144531666 |
---|---|
Provider Name | Joseph M Ajdinovich |
First Address | Mattoon, IL 61938-4653 |
Second Address | Effingham, IL 62401-1638 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2010 |
Last Update Date | 26/01/2022 |