Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 036.130998 | IL |
N | 208600000X | Surgeon | 036.130998 | IL |
Y | 2086S0102X | Surgical Critical Care | 036.130998 | IL |
N | 2086S0127X | Trauma Surgeon | 036.130998 | IL |
NPI | 1356583413 |
---|---|
Provider Name | Dr. Jonathan Frederick Bean |
First Address | Chicago, IL 60608-1782 |
Second Address | Chicago, IL 60608-1782 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2009 |
Last Update Date | 31/01/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036.130998 | (05) | IL |