Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0202X | Pediatric Cardiologist | 036050398 | IL |
NPI | 1235110958 |
---|---|
Provider Name | Mr. Earl Philip Ow |
First Address | Willow Brook, IL 60527-5343 |
Second Address | Oak Lawn, IL 60453-2600 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/11/2005 |
Last Update Date | 17/06/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036050398 | (05) | IL |
200029140 | INDYPA (01) | IN |
C45458 | (02) |