Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 125.075492 | IL |
NPI | 1063049468 |
---|---|
Provider Name | Nicolas Manuel Espinosa |
First Address | Chicago, IL 60611 |
Second Address | Chicago, IL 60611-2908 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/03/2020 |
Last Update Date | 11/06/2020 |