Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204F00000X | Transplant Surgeon | 036.083963 | IL |
N | 208200000X | Surgeon | 036083963 | IL |
N | 208600000X | Surgeon | 036083963 | IL |
NPI | 1770689143 |
---|---|
Provider Name | Enrico Benedetti |
First Address | Chicago, IL 60612-4325 |
Second Address | Chicago, IL 60612-4795 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/09/2006 |
Last Update Date | 25/04/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036.083963 | (05) | IL |
F88523 | (02) |