Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | IL |
NPI | 1013134378 |
---|---|
Provider Name | Dr. Paul Vizgirda |
First Address | Chicago, IL 60614-5487 |
Second Address | Chicago, IL 60614-5487 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2007 |
Last Update Date | 08/07/2007 |