Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 036.146033 | IL |
Y | 2080P0203X | Pediatric Critical Care Doctor | 036.146033 | IL |
NPI | 1295153047 |
---|---|
Provider Name | Andrew D Prigge |
First Address | Chicago, IL 60611-2991 |
Second Address | Chicago, IL 60611 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/03/2014 |
Last Update Date | 05/02/2022 |