Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | IL | |
N | 208600000X | Surgeon | IL | |
Y | 208G00000X | Cardiothoracic Vascular Surgeon | IL |
NPI | 1053418780 |
---|---|
Provider Name | Dr. Anton Schittek |
First Address | Mount Vernon, IL 62864-2372 |
Second Address | Mount Vernon, IL 62864-2372 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/09/2006 |
Last Update Date | 22/10/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
04126219 | BCBS (01) | IL |
174748 | HEALTHLINK (01) | IL |
A88218 | (02) | IL |