Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 02003678A | IN |
N | 111NI0900X | Internist | 02003678A | IN |
N | 207RC0000X | Internist - Cardiovascular Disease | 036-121887 | IL |
Y | 207RI0011X | Interventional Cardiology | 036-121887 | IL |
NPI | 1003055179 |
---|---|
Provider Name | Mr. Michael Robert Nuyles |
First Address | Aurora, IL 60506-6222 |
Second Address | North Aurora, IL 60542-5142 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/02/2009 |
Last Update Date | 18/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036121887 | (05) | IL |
200989680 | (05) | IN |