Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 036-073-830 | IL |
Y | 208600000X | Surgeon | 036-073-830 | IL |
N | 2082S0105X | Plastic Hand Surgeon | 036-073-830 | IL |
NPI | 1508831660 |
---|---|
Provider Name | Dr. Jerry Chow |
First Address | Orland Park, IL 60462-4600 |
Second Address | Orland Park, IL 60462-4600 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/02/2006 |
Last Update Date | 29/06/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0031602242 | BCBSIL (01) | IL |
036073830 | (05) | IL |
990007792 | PALMETTO GBA-RAILROAD MEDICARE (01) | |
D13578 | (02) | IL |