Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 036-098229 | IL |
N | 207PE0004X | Emergency Medical Services | 36098229 | IL |
NPI | 1013993104 |
---|---|
Provider Name | Christopher C Caudill |
First Address | Chicago, IL 60675-1001 |
Second Address | Lake Forest, IL 60045-1659 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/12/2005 |
Last Update Date | 22/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
36098229 | (05) | IL |
H32435 | (02) | IL |