Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0204X | Pediatric Emergency Doctor | 036094372 | IL |
NPI | 1265582290 |
---|---|
Provider Name | Martin A Bazi |
First Address | Chicago, IL 60637-1447 |
Second Address | Burr Ridge, IL 60527-6686 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/01/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036094372 | (05) | IL |