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 | 174400000X | Specialist | | 070004145 | 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 | 01634372 | OTHER | ILLINOIS | BCBS GROUP NO. |
| 2 | 200573902 | OTHER | ILLINOIS | TRANSIT REHABILITATION CENTERS OF CHICAGO |
| 3 | 200573902 | OTHER | ILLINOIS | TRANSIT REHAB CENTERS OF CHICAGO |
| 4 | 200573902 | OTHER | ILLINOIS | TAX ID BALANCE CTR OF IL |
| 5 | K14424 | MEDICARE UPIN | ILLINOIS | |
| 6 | 209881 | MEDICARE ID-TYPE UNSPECIFIED | ILLINOIS | MEDICARE GROUP NO. |
| 7 | 363396874 | OTHER | ILLINOIS | TAX ID PEAK THERAPEUTICS |
| 8 | 210877 | MEDICARE ID-TYPE UNSPECIFIED | ILLINOIS | MEDICARE GROUP NO. |
| 9 | 650007085 | OTHER | ILLINOIS | MEDICARE RAILROAD - PALMETTO GBA |
| 10 | 0296300002 | MEDICARE NSC | ILLINOIS | |
| 11 | K10345 | MEDICARE UPIN | ILLINOIS | |
| 12 | 1618443 | OTHER | IDAHO | BCBS IL GROUP ID |
