Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 036-091374 | IL |
Y | 2080P0203X | Pediatric Critical Care Doctor | 036-091374 | IL |
NPI | 1124053814 |
---|---|
Provider Name | Paul Severin |
First Address | Chicago, IL 60612-3833 |
Second Address | Chicago, IL 60612-3833 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2006 |
Last Update Date | 30/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G15227 | (02) | IL |