Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | 016002468 | IL |
NPI | 1043213713 |
---|---|
Provider Name | Dr. Vincent Anthony Perns |
First Address | Chicago, IL 60634-4684 |
Second Address | Chicago, IL 60634-4684 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2005 |
Last Update Date | 01/10/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
016002468 | (05) | IL |
T36829 | (02) | IL |