Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204F00000X | Transplant Surgeon | 036-050846 | IL |
NPI | 1245269869 |
---|---|
Provider Name | Stephen Jensik |
First Address | Chicago, IL 60612-3841 |
Second Address | Chicago, IL 60612-3841 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2006 |
Last Update Date | 29/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C44045 | (02) | IL |