is a Specialist in Winfield, Illinois. practices all healthcare services and medical treatments related to Specialist. The NPI Number for is 1407807035. The last update date is .
's current location address is 25 N. Winfield Road, Winfield, Illinois. You can contact this provider via phone number 6309334700 and fax number 6309334427. The mailing address for is 25 N. Winfield Road, Winfield, Illinois. To know further, please read the information below!
Provider Profile Detail
Provider Name | |
---|---|
Address | 25 N. Winfield Road, Winfield, Illinois |
Phone Number | 6309334700 |
Fax Number | 6309334427 |
Sole Proprietor | -- |
Credentials | -- |
NPI Number Detail
NPI Number | 1407807035 |
---|---|
Provider Enumeration Date | |
Last Updated Date |
Provider Mailing Address Detail
Address | 25 N. Winfield Road |
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City | Winfield |
State | Illinois (IL) |
Post Code | 601901295 |
Phone Number | 6309334700 |
Fax Number | 6309334427 |
Provider's Primary Taxonomy Detail
Speciality | Specialist |
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Taxonomy | 174400000X |
Licence No | 36068425 |
Definition: An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |
Provider's Other Legacy Identifiers
Identifier | Identifier Type | Identifier State | Identifier Issuer |
---|---|---|---|
P00924095 | MEDICARE RAILROAD (PROVIDER) | ||
206147 | MEDICARE PTAN (GROUP) | ||
CA4748 | MEDICARE RAILROAD (GROUP) | ||
206147048 | MEDICARE PTAN (INDIVIDUAL) | ||
36068425 | IL | -- | |
1617373 | IL | BCBS OF IL |
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