Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 036142018 | IL |
N | 207YX0905X | Otolaryngology/Facial Plastic Surgery | Q6786 | TX |
NPI | 1326338526 |
---|---|
Provider Name | Sudeep Roy |
First Address | Glenview, IL 60025-4940 |
Second Address | Arlington Heights, IL 60004-3985 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2011 |
Last Update Date | 24/01/2018 |