Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0120X | Pediatric Surgery | 036153770 | IL |
NPI | 1396036406 |
---|---|
Provider Name | Brian Gulack |
First Address | Hoffman Estates, IL 60169-1019 |
Second Address | Hoffman Estates, IL 60169-1019 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/04/2011 |
Last Update Date | 31/03/2021 |