Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 036-115185 | IL |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 036-115185 | IL |
NPI | 1104877182 |
---|---|
Provider Name | William R Sterba II |
First Address | Warrenville, IL 60555-3845 |
Second Address | Warrenville, IL 60555-3845 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/05/2006 |
Last Update Date | 01/04/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I52667 | (02) | IL |
P01126447 | RR MEDICARE (01) | IL |