Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | 041249572 | IL |
NPI | 1033715354 |
---|---|
Provider Name | Susan Takacs |
First Address | Chicago, IL 60611-6659 |
Second Address | Chicago, IL 60611-6659 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/12/2020 |
Last Update Date | 10/12/2020 |