Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | IL |
NPI | 1679604433 |
---|---|
Provider Name | Dr. Titus Gan Chiu |
First Address | Buffalo Grove, IL 60089-6315 |
Second Address | Park Ridge, IL 60068-1802 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/03/2007 |
Last Update Date | 08/07/2007 |