Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 036.148005 | IL |
Y | 208600000X | Surgeon | 036.148005 | IL |
NPI | 1003254079 |
---|---|
Provider Name | Dr. Eugene Park |
First Address | Chicago, IL 60611-5964 |
Second Address | Chicago, IL 60611-5964 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2013 |
Last Update Date | 08/01/2019 |