Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 036114622 | IL |
N | 208600000X | Surgeon | 036114622 | IL |
N | 2086S0102X | Surgical Critical Care | 036114622 | IL |
Y | 2086S0127X | Trauma Surgeon | 036114622 | IL |
NPI | 1487689816 |
---|---|
Provider Name | Ellen C Omi |
First Address | Oak Lawn, IL 60453-2654 |
Second Address | Oak Lawn, IL 60453-2654 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2006 |
Last Update Date | 10/11/2009 |