Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 036119081 | IL |
Y | 2080P0202X | Pediatric Cardiologist | 036119081 | IL |
NPI | 1205007994 |
---|---|
Provider Name | Dr. Joseph A. A. Camarda |
First Address | Chicago, IL 60611-2991 |
Second Address | Chicago, IL 60611-2991 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/03/2008 |
Last Update Date | 22/05/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036119081 | STATE LICENSE (01) | IL |