Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 019.014420 | IL |
Y | 213EG0000X | General Practice | 019.014420 | IL |
NPI | 1003077413 |
---|---|
Provider Name | Dr. Otto James Tor |
First Address | Orland Park, IL 60462-4402 |
Second Address | Orland Park, IL 60462-4402 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2008 |
Last Update Date | 18/06/2008 |