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 | 207RG0100X | Internal Medicine | Gastroenterology | 036129480 | 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 | 0769653000 | OTHER | PENNSYLVANIA | KEYSTONE HEALTH PLAN EAST |
| 2 | 0000673779 | OTHER | PENNSYLVANIA | HORIZON BLUE SHIELD |
| 3 | 0000348038 | OTHER | PENNSYLVANIA | BLAIR MILL |
| 4 | 0000673779 | OTHER | PENNSYLVANIA | BOEING BLUE SHIELD |
| 5 | 0769653000 | OTHER | PENNSYLVANIA | PERSONAL CHOICE |
| 6 | 00001981917 03 | OTHER | PENNSYLVANIA | UNITED HEALTH CARE |
| 7 | 0030907 | OTHER | PENNSYLVANIA | AETNA US HEALTHCARE |
| 8 | H11348 | MEDICARE UPIN | PENNSYLVANIA | |
| 9 | 0000348038 | OTHER | PENNSYLVANIA | PA. BLUE SHIELD |
| 10 | 0769653000 | OTHER | PENNSYLVANIA | AMERIHEALTH |
| 11 | 0000161491 | OTHER | PENNSYLVANIA | INDEPENDENCE BLUE CROSS |
