Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0400X | Neurologist | 036-086337 | IL |
NPI | 1023021466 |
---|---|
Provider Name | Matthew Meriggioli |
First Address | Chicago, IL 60612-4300 |
Second Address | Chicago, IL 60612-7232 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/08/2006 |
Last Update Date | 21/10/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G34092 | (02) |