Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0216X | Pediatric Rheumatologist | 125.067054 | IL |
NPI | 1124412416 |
---|---|
Provider Name | Nissim Stolberg |
First Address | Skokie, IL 60076-1457 |
Second Address | Chicago, IL 60645-3208 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/03/2015 |
Last Update Date | 08/11/2021 |