Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 36051379 | IL |
NPI | 1003990953 |
---|---|
Provider Name | Michael J Karasis |
First Address | Woodstock, IL 60098-3749 |
Second Address | Woodstock, IL 60098-3749 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2006 |
Last Update Date | 17/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D93804 | (02) | IL |