Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 125.068486 | IL |
Y | 208600000X | Surgeon | 125.068486 | IL |
NPI | 1013228907 |
---|---|
Provider Name | Dr. Timothy Peter Bruce |
First Address | Burr Ridge, IL 60527-7594 |
Second Address | Chicago, IL 60637-1447 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2010 |
Last Update Date | 18/05/2016 |