Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 036151963 | IL |
Y | 208600000X | Surgeon | 036151963 | IL |
N | 208200000X | Surgeon | 137384 | CA |
N | 208600000X | Surgeon | 137384 | CA |
N | 2086S0120X | Pediatric Surgery | A13384 | CA |
NPI | 1215311915 |
---|---|
Provider Name | Justin A Steggerda |
First Address | Chicago, IL 60611-2927 |
Second Address | Chicago, IL 60611-2927 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2015 |
Last Update Date | 25/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1215311915 | (05) | CA |