Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 041.392571 | IL |
NPI | 1003198235 |
---|---|
Provider Name | Michal Ora Mendelsberg |
First Address | Buffalo Grove, IL 60089 |
Second Address | Buffalo Grove, IL 60089 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/09/2011 |
Last Update Date | 14/09/2011 |