Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 036136962 | IL |
N | 207YX0007X | Plastic Surgeon (Head & Neck) | 32238 | TN |
NPI | 1396701942 |
---|---|
Provider Name | Dr. Sandeep Samant |
First Address | Chicago, IL 60611-5967 |
Second Address | Chicago, IL 60611-5967 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2006 |
Last Update Date | 31/08/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3846847 | (05) | TN |
H05322 | (02) |