Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | 036098202 | IL |
NPI | 1063454197 |
---|---|
Provider Name | Dr. Andy C. Chiou |
First Address | Peoria, IL 61606-2036 |
Second Address | Peoria, IL 61606-2037 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2006 |
Last Update Date | 26/09/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036098202-1 | (05) | IL |
7215166 | BCBS (01) | IL |
I07809 | (02) | IL |