Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251E1300X | Electrophysiology, Clinical | 070020308 | IL |
NPI | 1073085379 |
---|---|
Provider Name | Yash Kaushik |
First Address | Tinley Park, IL 60487-4473 |
Second Address | Crete, IL 60417-1623 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/12/2018 |
Last Update Date | 26/12/2018 |