Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RR0500X | Rheumatology | IL |
NPI | 1053349886 |
---|---|
Provider Name | Max L Harris |
First Address | Oak Park, IL 60302-2519 |
Second Address | Oak Park, IL 60302-2519 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
36056915 | (05) | IL |
C41979 | (02) | IL |