Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | 016003631 | IL |
NPI | 1073674081 |
---|---|
Provider Name | Brian E Bacardi |
First Address | Chicago, IL 60618-5811 |
Second Address | Chicago, IL 60618-5811 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/12/2006 |
Last Update Date | 08/05/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T61096 | (02) |