Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 036155421 | IL |
NPI | 1093395790 |
---|---|
Provider Name | Hidefumi Nishida |
First Address | Chicago, IL 60637-1443 |
Second Address | Chicago, IL 60637-1443 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/04/2021 |
Last Update Date | 08/04/2021 |