Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YS0123X | Facial Plastic Surgeon | 036.132226 | IL |
N | 208D00000X | General Practice Physician | OT012634 | PA |
NPI | 1588964357 |
---|---|
Provider Name | Krystyna Gal |
First Address | Orland Park, IL 60467-8788 |
Second Address | Orland Park, IL 60467-8788 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/10/2010 |
Last Update Date | 06/04/2017 |