Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0200X | Critical Care Medicine | IL |
NPI | 1053428375 |
---|---|
Provider Name | Raul Jaime Gazmuri |
First Address | Chicago, IL 60611-6427 |
Second Address | North Chicago, IL 60064-3048 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/08/2006 |
Last Update Date | 08/07/2007 |