Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | 125.075029 | IL |
NPI | 1124588264 |
---|---|
Provider Name | Calvin Chao |
First Address | Chicago, IL 60611-2908 |
Second Address | Chicago, IL 60611-2908 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/03/2019 |
Last Update Date | 20/06/2019 |