Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 036-098815 | IL |
N | 207XX0801X | Orthopaedic Trauma Surgeon | 36098815 | IL |
NPI | 1033183363 |
---|---|
Provider Name | Michael D Stover |
First Address | Chicago, IL 60611 |
Second Address | Chicago, IL 60611-3926 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/02/2006 |
Last Update Date | 04/02/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
36098815 | (05) | IL |
G84952 | (02) | |
L81088 | MEDICARE (01) | IL |