Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 36082006 | IL |
Y | 208600000X | Surgeon | 36082006 | IL |
N | 2086S0102X | Surgical Critical Care | 36082006 | IL |
N | 2086S0127X | Trauma Surgeon | 36082006 | IL |
NPI | 1104892389 |
---|---|
Provider Name | Thomas Esposito |
First Address | Maywood, IL 60153 |
Second Address | Maywood, IL 60153 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/02/2006 |
Last Update Date | 25/08/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B66794 | (02) |