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 | 207X00000X | Orthopaedic Surgery | | 036053597 | ILLINOIS | Yes |
| 2 | 207XS0117X | Orthopaedic Surgery | Orthopaedic Surgery of the Spine | 036053597 | ILLINOIS | No |
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 | 208821 | OTHER | | MEDICARE GRP KANE |
| 2 | K02958 | MEDICARE ID-TYPE UNSPECIFIED | ILLINOIS | MCHENRY COUNTY |
| 3 | 0354460005 | MEDICARE NSC | ILLINOIS | |
| 4 | 0354460001 | MEDICARE NSC | ILLINOIS | |
| 5 | CE6001 | OTHER | | RR MEDICARE GRP KANE |
| 6 | 0354460002 | MEDICARE NSC | ILLINOIS | |
| 7 | K07121 | MEDICARE ID-TYPE UNSPECIFIED | ILLINOIS | KANE COUNTY |
| 8 | 036053597 | MEDICAID | ILLINOIS | |
| 9 | 0354460003 | MEDICARE NSC | ILLINOIS | |
| 10 | 0354460004 | MEDICARE NSC | ILLINOIS | |
| 11 | 200017455 | OTHER | | RR MEDICARE PROV # |
| 12 | 207906 | OTHER | | MEDICARE GRP MCHENRY |
| 13 | CG2631 | OTHER | | RR MEDICARE GRP MCHENRY |
| 14 | D14718 | MEDICARE UPIN | | |