Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | IL |
NPI | 1174506026 |
---|---|
Provider Name | Mohammad Baig |
First Address | Orland Park, IL 60467-5496 |
Second Address | Orland Park, IL 60467-5496 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/11/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C43600 | (02) | IL |