Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 125059135 | IL |
N | 208600000X | Surgeon | 125059135 | IL |
Y | 2086S0102X | Surgical Critical Care | 036154132 | IL |
NPI | 1346533353 |
---|---|
Provider Name | Dr. John C Kubasiak |
First Address | Maywood, IL 60153-3328 |
Second Address | Maywood, IL 60153-3328 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2011 |
Last Update Date | 16/06/2021 |