NPI age
20 years
Enumerated 2005-09-16
Across 138 active surgery providers in Texas.
2 secondary locations on file with NPPES.
| Type | Value | Notes |
|---|---|---|
| 05 (IL) | 036083049 | |
| 01 (IL) | 1627123 | BCBS PROVIDER ID |
Part of a multi-provider practice. 246 other active providers share this practice address in NPPES.
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