Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0002X | Hospice and Palliative Medicine | 036130680 | IL |
NPI | 1164686218 |
---|---|
Provider Name | Wilfredo Jose Romero Ubillus |
First Address | Chicago, IL 60661-1377 |
Second Address | Oak Park, IL 60302 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2008 |
Last Update Date | 12/06/2018 |