Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207XS0117X | Orthopaedic Spine Surgeon | 01042908A | IN |
Y | 207XS0117X | Orthopaedic Spine Surgeon | 036 085125 | IL |
NPI | 1144204504 |
---|---|
Provider Name | Patrick J Sweeney |
First Address | Mokena, IL 60448-8595 |
Second Address | Mokena, IL 60448-8595 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/11/2005 |
Last Update Date | 19/03/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000220974 | ANTHEM (01) | IN |
01632167 | BCBS (01) | IL |
036085125 | (05) | IL |
20004327 CK7919 | RR MEDICARE (01) | IN |
200167380 | (05) | IN |
DO9194 | RR MEDICARE (01) | IL |
F79095 | (02) | |
P00217417-CK5647 | RR MEDICARE (01) | IL |