Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207SG0201X | Clinical Genetics (M.D.) | 036-073221 | IL |
N | 208000000X | Pediatrician | 036-073221 | IL |
NPI | 1164497483 |
---|---|
Provider Name | George Hoganson |
First Address | Chicago, IL 60612-4325 |
Second Address | Chicago, IL 60612-4325 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/02/2006 |
Last Update Date | 05/12/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
07215036 | BCBS (01) | IL |
D13589 | (02) | IL |
IL0194 | JOHN DEERE (01) | IL |