Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 036145005 | IL |
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 036145005 | IL |
NPI | 1295077550 |
---|---|
Provider Name | Dr. Edward Grant Sutter |
First Address | Warrenville, IL 60555-3846 |
Second Address | Warrenville, IL 60555 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/03/2013 |
Last Update Date | 30/10/2019 |