Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223E0200X | Endodontist | IL | |
N | 1223G0001X | General Practice | IL | |
N | 213EG0000X | General Practice | IL |
NPI | 1134333222 |
---|---|
Provider Name | Robert J Ceisel |
First Address | Chicago, IL 60610-3832 |
Second Address | Chicago, IL 60610-3832 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/05/2007 |
Last Update Date | 08/07/2007 |