Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 021.003058 | IL |
NPI | 1053604413 |
---|---|
Provider Name | Dr. Rahul Tandon |
First Address | Burr Ridge, IL 60527-6497 |
Second Address | Orland Park, IL 60467-4531 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2011 |
Last Update Date | 16/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7594406 | (05) | CA |