Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0000X | Internist - Cardiovascular Disease | 036070602 | IL |
Y | 207RC0001X | Clinical Cardiac Electrophysiologist | 036070602 | IL |
NPI | 1003864331 |
---|---|
Provider Name | Dr. John Dongas |
First Address | Chicago, IL 60674-6549 |
Second Address | New Lenox, IL 60451-9524 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/05/2006 |
Last Update Date | 24/02/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036070602 | (05) | IL |
D15791 | (02) | IL |