Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | 036133109 | IL |
NPI | 1841501962 |
---|---|
Provider Name | Dr. Bryant Shane Ho |
First Address | Chicago, IL 60611-4446 |
Second Address | Hinsdale, IL 60521-3186 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2010 |
Last Update Date | 21/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F400318957 | (02) | IL |
PENDING | (05) | IL |