NPI age
19 years
Enumerated 2006-07-22
Across 15966 active family medicine providers in Texas.
| Type | Value | Notes |
|---|---|---|
| 05 (IL) | 036116570 | |
| 01 (IL) | CA4079 | RR GROUP # |
| 01 (IL) | P00433545 | RR INDIVIDUAL # |
| 01 (IL) | 809840 | MEDICARE GROUP # |
Part of a multi-provider practice. 14 other active providers share this practice address in NPPES.
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