Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 64873-21 | WI |
N | 207YS0123X | Facial Plastic Surgeon | 64873-21 | WI |
NPI | 1336119858 |
---|---|
Provider Name | Christopher L Surek |
First Address | Deerfield, IL 60015-2709 |
Second Address | Deerfield, IL 60015-2709 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/01/2006 |
Last Update Date | 25/04/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1625965 | (05) | LA |
D15109 | (02) |