Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | 125.074121 | IL |
NPI | 1013575182 |
---|---|
Provider Name | Michael Mcginnis |
First Address | Chicago, IL 60607-2436 |
Second Address | Chicago, IL 60612-3833 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/06/2019 |
Last Update Date | 03/06/2019 |