Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 135.001092 | IL |
Y | 222Z00000X | Podiatrist | 135.001092 | IL |
NPI | 1003444266 |
---|---|
Provider Name | Roberto Caneva |
First Address | Oak Lawn, IL 60453-2600 |
Second Address | Oak Lawn, IL 60453-2600 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/03/2020 |
Last Update Date | 17/06/2020 |