Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RA0001X | Advanced Heart Failure and Transplant Cardiologist | 036-135917 | IL |
N | 207RC0000X | Internist - Cardiovascular Disease | 036-139517 | IL |
NPI | 1871736413 |
---|---|
Provider Name | Dr. Tisha Marie Borromeo Suboc |
First Address | Chicago, IL 60612 |
Second Address | Chicago, IL 60612-3883 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2009 |
Last Update Date | 30/04/2021 |