Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 125-070360 | IL |
N | 111NI0900X | Internist | 125-070360 | IL |
Y | 207RN0300X | Nephrologist | 036.155824 | IL |
N | 208000000X | Pediatrician | 125-070360 | IL |
N | 2080P0210X | Pediatric Nephrologist | 036.155824 | IL |
NPI | 1265961593 |
---|---|
Provider Name | Dr. Andrew Richard Vissing |
First Address | Chicago, IL 60611-2908 |
Second Address | Chicago, IL 60611-2908 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2017 |
Last Update Date | 24/06/2021 |