Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 036108413 | IL |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 036108413 | IL |
NPI | 1134138027 |
---|---|
Provider Name | Rolando Izquierdo JR. |
First Address | Milwaukee, IL 53278-8534 |
Second Address | Algonquin, IL 60102-5944 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/08/2006 |
Last Update Date | 14/01/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036108413 | (05) | IL |