Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 036-139425 | IL |
Y | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | 036139425 | IL |
NPI | 1831465806 |
---|---|
Provider Name | Dr. Julia Geynisman-Tan |
First Address | Chicago, IL 60611-2955 |
Second Address | Chicago, IL 60611-2955 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2012 |
Last Update Date | 23/04/2021 |