Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RN0300X | Nephrologist | 036040403 | IL |
NPI | 1053313072 |
---|---|
Provider Name | Paul Balter |
First Address | Oak Park, IL 60302-4420 |
Second Address | Oak Park, IL 60302-4420 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2005 |
Last Update Date | 10/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036040403 | (05) | IL |
C41850 | (02) | IL |