Taxonomy Codes
The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:
| No. |
Taxonomy Code |
Taxonomy Clasification |
Taxonomy Specialization |
License Number |
License State |
Primary |
| 1 | 208G00000X | Thoracic Surgery (Cardiothoracic Vascular Surgery) | | 036109293 | ILLINOIS | Yes |
Other Identifiers
The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.
| No. |
Other Provider Identifier |
Other Provider Identifier Type |
Other Provider Identifier State |
Other Provider Identifier Issuer |
| 1 | 036109293001 | OTHER | | OSF HEALTH PLANS |
| 2 | 37972 | OTHER | | TRICARE |
| 3 | IL0106 | OTHER | | JOHN DEERE HEALTH PLAN |
| 4 | 05732036 | OTHER | ILLINOIS | BLUE SHIELD GROUP NUMBER |
| 5 | 566399 | OTHER | | HEALTHLINK |
| 6 | 276560 | OTHER | | PERSONAL CARE |
| 7 | L98313 | MEDICARE PIN | ILLINOIS | |
| 8 | 2299329 | OTHER | | UNITED HEALTHCARE |
| 9 | 37875 | OTHER | | PHCS |
| 10 | 084529 | OTHER | ILLINOIS | HEALTH ALLIANCE PROVIDER |
| 11 | 204597405 | MEDICAID | MISSOURI | |
| 12 | P00007635 | MEDICARE PIN | | |
| 13 | 036109293 | MEDICAID | ILLINOIS | |
| 14 | H82765 | MEDICARE UPIN | | |