Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | 036065284 | IL |
NPI | 1043287196 |
---|---|
Provider Name | Rafael Piedra |
First Address | Chicago, IL 60674-0018 |
Second Address | Naperville, IL 60540-6550 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/03/2006 |
Last Update Date | 27/01/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036065284 | (05) | IL |