Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 036.036945 | IL |
Y | 207XS0117X | Orthopaedic Spine Surgeon | 036.036945 | IL |
NPI | 1194274530 |
---|---|
Provider Name | Ronald Dewald |
First Address | Lake Forest, IL 60045-4813 |
Second Address | Lake Forest, IL 60045-4813 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2016 |
Last Update Date | 27/09/2016 |