Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 036082189 | IL |
Y | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | 036.088595 | IL |
NPI | 1427067990 |
---|---|
Provider Name | Dr. Sean George |
First Address | Chicago, IL 60657-5190 |
Second Address | Chicago, IL 60657-8480 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2006 |
Last Update Date | 28/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
36088595 | (05) | IL |
G13904 | (02) | IL |