Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208D00000X | General Practice Physician | 036123598 | IL |
N | 208D00000X | General Practice Physician | MD038009 | DC |
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 036123598 | IL |
NPI | 1023245693 |
---|---|
Provider Name | Di Fan |
First Address | Northbrook, IL 60062-1900 |
Second Address | Elk Grove Village, IL 60007-3372 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2009 |
Last Update Date | 30/11/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036123598 | (05) | IL |
MD038009 | LICENSE (01) | DC |