Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0105X | Surgery of the Hand | IL |
NPI | 1235131244 |
---|---|
Provider Name | Dr. Bangalore N Jayaram |
First Address | Chicago, IL 60674-0035 |
Second Address | Chicago, IL 60608-1732 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036-044772-3 | (05) | IL |
D13167 | (02) | IL |