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 | 207RP1001X | Internal Medicine | Pulmonary Disease | 036 091943 | 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 | 205106 | MEDICARE ID-TYPE UNSPECIFIED | ILLINOIS | |
| 2 | H13874 | MEDICARE UPIN | ILLINOIS | |
| 3 | 036 091943 | MEDICAID | ILLINOIS | |
| 4 | K38583 | MEDICARE PIN | ILLINOIS | |
| 5 | P00001224 | OTHER | ILLINOIS | RAILROAD MEDICARE |
| 6 | 101 32066 | OTHER | ILLINOIS | BLUE CROSS BLUE SHIELD |