Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 036072375 | IL |
N | 207YX0007X | Plastic Surgeon (Head & Neck) | 036-072375 | IL |
NPI | 1235138546 |
---|---|
Provider Name | Dr. Thomas J Nielsen |
First Address | Chicago, IL 60612-4861 |
Second Address | Chicago, IL 60612-4861 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2005 |
Last Update Date | 04/05/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036072375 | (05) | IL |
CB1567 | RRMC (01) | IL |
E18388 | (02) | IL |