Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 036121764 | IL |
N | 111NI0900X | Internist | 036121764 | IL |
Y | 207RA0001X | Advanced Heart Failure and Transplant Cardiologist | 036121764 | IL |
N | 207RC0000X | Internist - Cardiovascular Disease | 036121764 | IL |
NPI | 1710125109 |
---|---|
Provider Name | Dr. Sunil Pauwaa |
First Address | Oak Lawn, IL 60453-6459 |
Second Address | Oak Lawn, IL 60453-6459 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/01/2009 |
Last Update Date | 17/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036121764 | (05) | IL |