Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223S0112X | Oral and Maxillofacial Surgeon | 021002374 | IL |
Y | 2086S0122X | Plastic and Reconstructive Surgery | 36091195 | IL |
NPI | 1194792911 |
---|---|
Provider Name | Dr. Victor Cimino |
First Address | Park Ridge, IL 60068-4267 |
Second Address | Park Ridge, IL 60068-4267 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/03/2006 |
Last Update Date | 08/06/2020 |