Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PP0204X | Pediatric Emergency Physician | 036109474 | IL |
N | 208000000X | Pediatrician | 036109474 | IL |
NPI | 1578525507 |
---|---|
Provider Name | Yiannis Limcaoco Katsogridakis |
First Address | Chicago, IL 60614-3394 |
Second Address | Chicago, IL 60614-3394 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/04/2006 |
Last Update Date | 08/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036109474 | (05) | IL |
G45738 | (02) |