Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 125047439 | IL |
N | 207X00000X | Orthopaedic Surgeon | 35.092590 | OH |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 036125154 | IL |
NPI | 1134385677 |
---|---|
Provider Name | Dr. Gregory Hampton Dairyko JR. |
First Address | Chicago, IL 60674-0018 |
Second Address | Elmhurst, IL 60126-5660 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/08/2008 |
Last Update Date | 03/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036125154 | (05) | IL |