Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 036123981 | IL |
N | 111NI0900X | Internist | 036123981 | IL |
N | 207RC0200X | Critical Care Medicine | 036.123981 | IL |
Y | 207RP1001X | Pulmonary Disease | 036123981 | IL |
NPI | 1073713418 |
---|---|
Provider Name | Craig Backous |
First Address | Chicago, IL 60625-3645 |
Second Address | Chicago, IL 60625-3645 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2007 |
Last Update Date | 30/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036100805 | (05) | IL |
406120113 | PTAN (01) |