Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 036-115128 | IL |
NPI | 1053325233 |
---|---|
Provider Name | Dr. Jason G Cundiff |
First Address | Barrington, IL 60010-2396 |
Second Address | Barrington, IL 60010-2396 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2006 |
Last Update Date | 18/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036115128 1 | (05) | IL |
I58589 | (02) |