Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0120X | Pediatric Surgery | 036-095767 | IL |
NPI | 1528053451 |
---|---|
Provider Name | Dr. Riccardo Superina |
First Address | Chicago, IL 60611-2991 |
Second Address | Chicago, IL 60611-2991 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/09/2005 |
Last Update Date | 25/10/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G60075 | (02) | IL |