Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | IL | |
N | 208600000X | Surgeon | IL | |
N | 2082S0105X | Plastic Hand Surgeon | IL |
NPI | 1053339259 |
---|---|
Provider Name | Dr. Vincent James Pelletiere |
First Address | Inverness, IL 60067-1215 |
Second Address | Inverness, IL 60067-1215 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D13264 | (02) | IL |