Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 036120810 | IL |
N | 207Q00000X | Family Doctor | 51956-020 | WI |
NPI | 1003028143 |
---|---|
Provider Name | Dr. Ernesto Estor |
First Address | Chicago, IL 60659-3324 |
Second Address | Chicago, IL 60659-3324 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2007 |
Last Update Date | 27/08/2012 |