Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 036063475 | IL |
Y | 207XS0117X | Orthopaedic Spine Surgeon | 036063475 | IL |
NPI | 1528040490 |
---|---|
Provider Name | Jack G Casini |
First Address | Chicago, IL 60674-0018 |
Second Address | Lombard, IL 60148-4932 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/11/2005 |
Last Update Date | 20/01/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036063475 | (05) | IL |