Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 036.050126 | IL |
NPI | 1326321431 |
---|---|
Provider Name | Dr. Bernard Carl Pecaro |
First Address | Carol Stream, IL 60188-2756 |
Second Address | Carol Stream, IL 60188-2756 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/09/2011 |
Last Update Date | 25/09/2011 |