Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | IL |
NPI | 1053307215 |
---|---|
Provider Name | Tord Alden |
First Address | Chicago, IL 60678-0001 |
Second Address | Chicago, IL 60614-3363 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/09/2005 |
Last Update Date | 11/03/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1627123 | BCBS PROVIDER ID (01) | IL |
OTHOOO | (02) | IL |