Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | IL |
NPI | 1174522171 |
---|---|
Provider Name | Dr. Susan Chua Apolinario |
First Address | Oak Lawn, IL 60453-2654 |
Second Address | Oak Lawn, IL 60453-2654 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2005 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E68226 | (02) | IL |