Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 036115037 | IL |
N | 207QG0300X | Family Doctor - Geriatric Medicine | 036115037 | IL |
N | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 036115037 | IL |
NPI | 1104846963 |
---|---|
Provider Name | Joseph Cyriac |
First Address | Chicago, IL 60673-3554 |
Second Address | Chicago, IL 60624-3312 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2006 |
Last Update Date | 23/05/2019 |