Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0204X | Pediatric Emergency Doctor | 036.146561 | IL |
NPI | 1255725164 |
---|---|
Provider Name | Princy Pathalil George |
First Address | Chicago, IL 60637 |
Second Address | Chicago, IL 60637 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2015 |
Last Update Date | 10/07/2018 |