Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 036095424 | IL |
NPI | 1003896903 |
---|---|
Provider Name | Dr. Thomas E Burns |
First Address | Joliet, IL 60431-9341 |
Second Address | Joliet, IL 60431-9341 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/01/2006 |
Last Update Date | 23/03/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036095424 | (05) | IL |
H14344 | (02) | IL |