Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RI0200X | Infectious Disease | 036126289 | IL |
N | 207RI0200X | Infectious Disease | 103894 | MN |
NPI | 1023278769 |
---|---|
Provider Name | Geoffrey Tsaras |
First Address | Milwaukee, WI 53278-8866 |
Second Address | Rockford, IL 61104-2200 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2008 |
Last Update Date | 12/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036126289 | (05) | IL |
ENROLLED | (05) | MN |
P00746355 | MEDICARE, RAILROAD (01) | MN |