Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | 019016766 | IL |
N | 208200000X | Surgeon | 036075892 | IL |
N | 208600000X | Surgeon | 036075892 | IL |
NPI | 1477622801 |
---|---|
Provider Name | Mark J Steinberg |
First Address | Maywood, IL 60153 |
Second Address | Maywood, IL 60153 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/11/2006 |
Last Update Date | 13/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C90843 | (02) |