Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | 213000319 | IL |
N | 222Z00000X | Podiatrist | 213000319 | IL |
Y | 224P00000X | Prosthetist | 211000291 | IL |
NPI | 1447747308 |
---|---|
Provider Name | Michael Elsen |
First Address | Oakbrook Terrace, IL 60181-3985 |
Second Address | Chicago, IL 60612-3836 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2018 |
Last Update Date | 17/04/2018 |