Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2086S0102X | Surgical Critical Care | 036-087054 | IL |
Y | 2086S0102X | Surgical Critical Care | 042.0014189 | VT |
N | 2086S0127X | Trauma Surgeon | 036-087054 | IL |
NPI | 1093829830 |
---|---|
Provider Name | Dr. Gary Chun-I An |
First Address | Chicago, IL 60622-4517 |
Second Address | Burlington, VT 05401-1473 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2006 |
Last Update Date | 04/10/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
356670 | (05) | IL |
F63083 | (02) | IL |