Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204F00000X | Transplant Surgeon | 036154800 | IL |
N | 204F00000X | Transplant Surgeon | 42680 | WI |
Y | 208200000X | Surgeon | 036154800 | IL |
Y | 208600000X | Surgeon | 036154800 | IL |
NPI | 1497711196 |
---|---|
Provider Name | Luis A Fernandez |
First Address | Maywood, IL 60153-3328 |
Second Address | Maywood, IL 60153-3328 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/04/2006 |
Last Update Date | 07/05/2021 |