Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0120X | Pediatric Surgery | 036068514 | IL |
NPI | 1225023153 |
---|---|
Provider Name | Frank Vicari |
First Address | Chicago, IL 60678-1354 |
Second Address | Chicago, IL 60611-2605 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/09/2005 |
Last Update Date | 11/06/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036068514 | (05) | IL |
1627123 | BCBS PROVIDER ID (01) | IL |
E24552 | (02) | IL |