Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | IL |
NPI | 1184786501 |
---|---|
Provider Name | Philip N Bushnick |
First Address | Hoffman Estates, IL 60194-5029 |
Second Address | Hoffman Estates, IL 60194-5029 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/12/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1625882 | BLUE CROSS BLUE SHIELD (01) | IL |
C42677 | (02) | IL |