Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0106X | Orthopaedic Hand Surgeon | 36074824 | IL |
NPI | 1124080189 |
---|---|
Provider Name | Thomas A Wiedrich |
First Address | Chicago, IL 60611-6662 |
Second Address | Chicago, IL 60611-6662 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/04/2006 |
Last Update Date | 01/12/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036074824 | (05) | IL |
E88284 | (02) |