Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207ND0900X | Dermatopathologist | 125060741 | IL |
NPI | 1548517949 |
---|---|
Provider Name | Michael Sidiropoulos |
First Address | Chicago, IL 60611-4854 |
Second Address | Chicago, IL 60611-2997 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/08/2012 |
Last Update Date | 14/08/2012 |