Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | IL | |
Y | 111NI0900X | Internist | IL | |
N | 207RC0200X | Critical Care Medicine | IL | |
N | 207RP1001X | Pulmonary Disease | IL |
NPI | 1053369066 |
---|---|
Provider Name | Rong Shang Tu |
First Address | Lombard, IL 60148-5371 |
Second Address | Lombard, IL 60148-5371 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2006 |
Last Update Date | 15/11/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02215074 | BLUE SHIELD PROVIDER NUMB (01) | IL |
C39551 | (02) | IL |