Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 4301108161 | MI |
N | 2080N0001X | Neonatal-Perinatal Doctor | 036.146598 | IL |
NPI | 1114308020 |
---|---|
Provider Name | Scottie Paitl |
First Address | Maywood, IL 60153-3328 |
Second Address | Maywood, IL 60153 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2015 |
Last Update Date | 20/07/2018 |