Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | IL | |
Y | 208600000X | Surgeon | IL |
NPI | 1023035565 |
---|---|
Provider Name | Mr. Ronald B Neal |
First Address | Chicago, IL 60619 |
Second Address | Chicago, IL 60619 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D12790 | (02) |