Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | 036-090814 | IL |
NPI | 1124322516 |
---|---|
Provider Name | Dr. Lewis Schwartz |
First Address | Chicago, IL 60045-1447 |
Second Address | Abbott Park, IL 60064-1447 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/12/2010 |
Last Update Date | 31/01/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G14747 | (02) | IL |