Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0200X | Critical Care Medicine | 36078568 | IL |
NPI | 1083663280 |
---|---|
Provider Name | Nathan Lidsky |
First Address | Carol Stream, IL 60122-4392 |
Second Address | Arlington Heights, IL 60005 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2006 |
Last Update Date | 15/01/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0360785681 | (05) | IL |
0360785682 | (05) | IL |
E85179 | (02) | |
P00249292 | RAILROAD MEDICARE (01) | IL |