Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RN0300X | Nephrologist | 036.152181 | IL |
NPI | 1033579867 |
---|---|
Provider Name | Stanislav Ozhog |
First Address | Maywood, IL 60153-3328 |
Second Address | Maywood, IL 60153-3328 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/03/2016 |
Last Update Date | 29/05/2020 |