Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | 016004484 | IL |
NPI | 1265651905 |
---|---|
Provider Name | Cayetano Puzon |
First Address | Chicago, IL 60611-6203 |
Second Address | Chicago, IL 60640-2514 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
016004484 | (05) | IL |
UO9551 | (02) | IL |