Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | IL | |
N | 207YX0905X | Otolaryngology/Facial Plastic Surgery | IL |
NPI | 1770519936 |
---|---|
Provider Name | Dr. Samuel J Girgis |
First Address | Hinsdale, IL 60521-3635 |
Second Address | Hinsdale, IL 60521-3635 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0004111211 | AETNA (01) | IL |
D16501 | (02) | IL |