Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | 213.000360 | IL |
N | 222Z00000X | Podiatrist | 213.000360 | IL |
Y | 224P00000X | Prosthetist | 211.000327 | IL |
NPI | 1063062370 |
---|---|
Provider Name | Michael Socie |
First Address | Chicago, IL 60611-3167 |
Second Address | Chicago, IL 60611-3167 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/09/2019 |
Last Update Date | 18/09/2019 |