Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207VG0400X | Gynecologist | 036118630 | IL |
Y | 207VX0000X | Obstetrician | 036118630 | IL |
NPI | 1194984575 |
---|---|
Provider Name | Ms. Lisa M Masinter |
First Address | Chicago, IL 60610-3439 |
Second Address | Chicago, IL 60612-3833 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2008 |
Last Update Date | 02/06/2008 |