Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204F00000X | Transplant Surgeon | 336100546 | IL |
N | 208200000X | Surgeon | 336100546 | IL |
N | 208600000X | Surgeon | 336100546 | IL |
NPI | 1053754549 |
---|---|
Provider Name | Dr. Mario Spaggiari |
First Address | Chicago, IL 60612-4325 |
Second Address | Chicago, IL 60612-4325 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/04/2013 |
Last Update Date | 02/02/2018 |