Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0300X | Geriatric Medicine | 036-039467 | IL |
N | 207V00000X | Obstetrician & Gynecologist | 036039467 | IL |
NPI | 1104936392 |
---|---|
Provider Name | Joseph R. Misulonas |
First Address | Chicago, IL 60642-2473 |
Second Address | Chicago, IL 60642-2473 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 05/12/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036039467 | (05) | IL |