Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 036146102 | IL |
N | 208600000X | Surgeon | 036146102 | IL |
N | 2086S0102X | Surgical Critical Care | 036146102 | IL |
Y | 2086S0120X | Pediatric Surgery | 036146102 | IL |
N | 2086S0120X | Pediatric Surgery | ME121030 | FL |
N | 2086S0120X | Pediatric Surgery | PG163428 | OR |
NPI | 1437372828 |
---|---|
Provider Name | Dr. Thomas Leslie Sims JR. |
First Address | Chicago, IL 60612-4325 |
Second Address | Chicago, IL 60612 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/04/2007 |
Last Update Date | 30/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036146102 | (05) | IL |