NPI age
18 years
Enumerated 2008-01-14
Across 15966 active family medicine providers in Texas.
| Type | Value | Notes |
|---|---|---|
| 05 (IL) | 036122188-1 | |
| 01 (IL) | 09015685 | BCBS OF IL |
| 01 (IL) | 779491 | MEDICARE PTAN |
Part of a multi-provider practice. 6 other active providers share this practice address in NPPES.
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