Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0216X | Pediatric Rheumatologist | 036089317 | IL |
NPI | 1336104348 |
---|---|
Provider Name | Marisa Sue Klein-Gitelman |
First Address | Chicago, IL 60614 |
Second Address | Chicago, IL 60614 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2006 |
Last Update Date | 21/09/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036039317 | (05) | IL |
F67774 | (02) |