Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | IL |
NPI | 1114986676 |
---|---|
Provider Name | Joao Gabriel Ubatuba |
First Address | Westmont, IL 60559-5511 |
Second Address | Elmhurst, IL 60126-5626 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/03/2006 |
Last Update Date | 27/12/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01616966 | BCBS PROVIDER ID (01) | IL |
C40381 | (02) | IL |