Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 036110662 | IL |
N | 207ND0900X | Dermatopathologist | 036110662 | IL |
NPI | 1467462929 |
---|---|
Provider Name | Lady C Dy |
First Address | Glenview, IL 60025-2121 |
Second Address | Glenview, IL 60025-2121 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/08/2006 |
Last Update Date | 06/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0361106621 | (05) | IL |
I03891 | (02) |