Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 01076181A | IN |
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 036-123787 | IL |
NPI | 1194935064 |
---|---|
Provider Name | Jason Gregory Hurbanek |
First Address | Hinsdale, IL 60521-3186 |
Second Address | Joliet, IL 60435-8427 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2007 |
Last Update Date | 05/10/2021 |