Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0200X | Critical Care Medicine | 36060576 | IL |
N | 207RP1001X | Pulmonary Disease | 36060576 | IL |
NPI | 1013994995 |
---|---|
Provider Name | Patrick Fahey |
First Address | Maywood, IL 60153 |
Second Address | Maywood, IL 60153 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/12/2005 |
Last Update Date | 03/09/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
36060576 | (05) | IL |
C40087 | (02) |