Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | 036049286 | IL |
NPI | 1114975232 |
---|---|
Provider Name | Dr. Tao Chen |
First Address | Woodstock, IL 60098-3188 |
Second Address | Woodstock, IL 60098-7517 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2006 |
Last Update Date | 08/04/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
160030419 | MEDICARE RAILROAD (01) | IL |