Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 036102985 | IL |
N | 207YS0123X | Facial Plastic Surgeon | 036102985 | IL |
NPI | 1740231810 |
---|---|
Provider Name | Dr. John D Ortega |
First Address | Warrenville, IL 60555-4025 |
Second Address | Elmhurst, IL 60126-5630 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/05/2006 |
Last Update Date | 21/06/2021 |