Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VE0102X | Reproductive Endocrinologist | 036062927 | IL |
NPI | 1477952026 |
---|---|
Provider Name | Mr. Jacob Moise |
First Address | Glenview, IL 60025 |
Second Address | Glenview, IL 60025 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/08/2014 |
Last Update Date | 20/08/2014 |