Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 036145716 | IL |
N | 111NI0900X | Internist | 036145716 | IL |
Y | 207RA0001X | Advanced Heart Failure and Transplant Cardiologist | 036145716 | IL |
N | 207RC0000X | Internist - Cardiovascular Disease | 036145716 | IL |
NPI | 1760778880 |
---|---|
Provider Name | Christopher Jared Sciamanna |
First Address | Mokena, IL 60448-8399 |
Second Address | Oak Lawn, IL 60453 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2011 |
Last Update Date | 17/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036145716 | (05) | IL |