Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | G88065 | CA |
N | 208200000X | Surgeon | 036127019 | IL |
N | 208600000X | Surgeon | 036127019 | IL |
Y | 2086S0120X | Pediatric Surgery | 036127019 | IL |
N | 208D00000X | General Practice Physician | G88065 | CA |
NPI | 1376525550 |
---|---|
Provider Name | Thom E. Lobe |
First Address | Chicago, IL 60612-4325 |
Second Address | Chicago, IL 60612 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/11/2005 |
Last Update Date | 26/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036127019 | (05) | IL |
B24436 | (02) |