Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0120X | Pediatric Surgery | IL |
NPI | 1144216169 |
---|---|
Provider Name | John Raffensperger |
First Address | Chicago, IL 60678-1354 |
Second Address | Chicago, IL 60614-3363 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2005 |
Last Update Date | 08/07/2007 |