Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 036-139777 | IL |
Y | 207VX0201X | Gynecologic Oncologist | 036139777 | IL |
N | 207VX0201X | Gynecologic Oncologist | 25MA07442500 | NJ |
NPI | 1235214982 |
---|---|
Provider Name | Wilberto Nieves Neira |
First Address | Chicago, IL 60611-4546 |
Second Address | Chicago, IL 60611-2914 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2006 |
Last Update Date | 28/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8990905 | (05) | IL |
8990905 | (05) | NJ |
G69362 | (02) | IL |
G69362 | (02) | NJ |