Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0203X | Pediatric Critical Care Doctor | 036-069789 | IL |
NPI | 1275543761 |
---|---|
Provider Name | Lev Podorovsky |
First Address | Chicago, IL 60707-3351 |
Second Address | Chicago, IL 60707-3351 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/08/2006 |
Last Update Date | 10/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F19519 | (02) |