Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 036072083 | IL |
NPI | 1033190814 |
---|---|
Provider Name | Carl E Arentzen |
First Address | Springfield, IL 62794-9684 |
Second Address | Springfield, IL 62701-1034 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/11/2005 |
Last Update Date | 24/10/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036072083 | (05) | IL |
C46074 | (02) |