Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 36-46439 | IL |
N | 111NI0900X | Internist | 36-46439 | IL |
Y | 207RG0100X | Gastroenterologist | 36-46439 | IL |
NPI | 1003587049 |
---|---|
Provider Name | Dr. Gerard Dennis Cerniak |
First Address | Joliet, IL 60431-4852 |
Second Address | Joliet, IL 60431-4852 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2021 |
Last Update Date | 15/12/2021 |