Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | IL |
NPI | 1154453462 |
---|---|
Provider Name | Mr. Yousif A Namrood |
First Address | Chicago, IL 60659-1502 |
Second Address | Chicago, IL 60659-1502 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/03/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
363275384001 | (05) | IL |