Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 036-093204 | IL |
NPI | 1003860750 |
---|---|
Provider Name | Steven Haddad |
First Address | Des Plaines, IL 60016-2359 |
Second Address | Glenview, IL 60025-7645 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2006 |
Last Update Date | 04/09/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036-093204 | (05) | IL |
G14164 | (02) | IL |