Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 036123563 | IL |
NPI | 1043477052 |
---|---|
Provider Name | Patrick Michael Birmingham |
First Address | Chicago, IL 60611-8701 |
Second Address | Chicago, IL 60611 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2008 |
Last Update Date | 16/02/2021 |