Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | 036040753 | IL |
Y | 207QA0401X | Family Doctor - Addiction Medicine | 036040753 | IL |
NPI | 1164572319 |
---|---|
Provider Name | Dr. John J Gnap |
First Address | Chicago Ridge, IL 60415 |
Second Address | Chicago Ridge, IL 60415 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/01/2007 |
Last Update Date | 30/03/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02201177 | BCBS (01) | IL |
C38226 | (02) |