Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RX0202X | Medical Oncology | 036118492 | IL |
NPI | 1114183290 |
---|---|
Provider Name | Syed Abutalib |
First Address | Chicago, IL 60674-0023 |
Second Address | Zion, IL 60099-2676 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/07/2008 |
Last Update Date | 29/07/2008 |