David Fireside, LCMT

NPI #1134526171 in Deerfield, Illinois

Provider Information

NPI Number: 1134526171
Entity Type: Individual
Name: David Fireside, LCMT
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Specialist
Credential: LCMT
Enumeration Date: Nov 19, 2014
Last Updated: Nov 19, 2014

Practice Location

Address: 108 WILMOT RD
City: Deerfield
State: Illinois
ZIP Code: 60015-5145
Phone: (847) 580-0002

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Specialist	174400000X	Primary

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