Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 036.125055 | IL |
NPI | 1033239835 |
---|---|
Provider Name | Dr. Travis Owen Abicht |
First Address | Chicago, IL 60611-3197 |
Second Address | Chicago, IL 60611-3197 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/03/2007 |
Last Update Date | 09/07/2013 |