Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | IL | |
N | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | IL | |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | IL |
NPI | 1245226968 |
---|---|
Provider Name | Timothy C. Payne |
First Address | Lisle, IL 60532-3698 |
Second Address | Downers Grove, IL 60515-2268 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2005 |
Last Update Date | 04/03/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C43764 | (02) | IL |