Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | 036062075 | IL |
NPI | 1003862863 |
---|---|
Provider Name | Manuel Barrera |
First Address | Chicago Hts, IL 60411-1748 |
Second Address | Chicago Hts, IL 60411-1748 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/05/2006 |
Last Update Date | 28/12/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036062075 | (05) | IL |
C45758 | (02) |