Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VE0102X | Reproductive Endocrinologist | 036.146445 | IL |
NPI | 1154602670 |
---|---|
Provider Name | Mohamad Irani |
First Address | Brooklyn, NY 11219 |
Second Address | Gurnee, IL 60031-3322 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2011 |
Last Update Date | 09/10/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036.146445 | MEDICAL LIC (01) | IL |