Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 036.138368 | IL |
NPI | 1033354592 |
---|---|
Provider Name | Dr. David Duston Odell |
First Address | Chicago, IL 60611-5975 |
Second Address | Chicago, IL 60611-5975 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/12/2008 |
Last Update Date | 04/01/2021 |