Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 036-148203 | IL |
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | 036-148203 | IL |
NPI | 1063484814 |
---|---|
Provider Name | Dr. Norman Y Otsuka |
First Address | Springfield, IL 62794-9638 |
Second Address | Springfield, IL 62702-5310 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/02/2006 |
Last Update Date | 10/12/2020 |