Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | 016005864 | IL |
N | 213ES0103X | Foot & Ankle Surgery | 5901002708 | MI |
NPI | 1093237596 |
---|---|
Provider Name | Joshua Nathan Riegelhaupt |
First Address | Highland Park, IL 60035-2223 |
Second Address | Gurnee, IL 60031-3380 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2017 |
Last Update Date | 02/05/2020 |