Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 036.151962 | IL |
NPI | 1013304559 |
---|---|
Provider Name | Jean-Luc Delafontaine |
First Address | Chicago, IL 60612 |
Second Address | Chicago, IL 60612 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/04/2015 |
Last Update Date | 13/08/2020 |