Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | 036.144900 | IL |
NPI | 1013259241 |
---|---|
Provider Name | Zachary John Bastian |
First Address | Downers Grove, IL 60515-1500 |
Second Address | Downers Grove, IL 60515-1500 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/03/2013 |
Last Update Date | 10/09/2019 |