Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0007X | Plastic Surgeon (Head & Neck) | 036043341 | IL |
NPI | 1558646745 |
---|---|
Provider Name | Dr. Peter Anthony Brusca |
First Address | Chicago, IL 60610-2168 |
Second Address | Chicago, IL 60610-2168 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/10/2011 |
Last Update Date | 19/10/2011 |