Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207ND0101X | MOHS-Micrographic Surgeon | 036.147753 | IL |
NPI | 1235450420 |
---|---|
Provider Name | Renato Goreshi |
First Address | Hoffman Estates, IL 60169-2049 |
Second Address | Toms River, NJ 08753-6407 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2010 |
Last Update Date | 17/12/2018 |