Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist | 211-000175 | IL |
NPI | 1053642918 |
---|---|
Provider Name | Qingyuan Du |
First Address | Chicago, IL 60611-5757 |
Second Address | Chicago, IL 60611-2654 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/01/2010 |
Last Update Date | 15/01/2010 |