Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207K00000X | Allergist & Immunologist | 01074995A | IN |
N | 207K00000X | Allergist & Immunologist | 036112220 | IL |
N | 2080P0201X | Pediatric Allergist | 01074995A | IN |
Y | 2080P0201X | Pediatric Allergist | 036112220 | IL |
NPI | 1760555858 |
---|---|
Provider Name | Christina E Ciaccio |
First Address | Chicago, IL 60637 |
Second Address | Chicago, IL 60637-1425 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/11/2006 |
Last Update Date | 22/07/2015 |