Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208G00000X | Cardiothoracic Vascular Surgeon | 036.143737 | IL |
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 5499 | OK |
NPI | 1003063173 |
---|---|
Provider Name | Mr. Peter Ungjo Baik |
First Address | Chicago, IL 60674 |
Second Address | Zion, IL 60099 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/08/2008 |
Last Update Date | 13/08/2021 |