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 | 207L00000X | Anesthesiology | | 25969 | WISCONSIN | No |
| 2 | 207LP2900X | Anesthesiology | Pain Medicine | 036074138 | ILLINOIS | No |
| 3 | 208VP0014X | Pain Medicine | Interventional Pain Medicine | 036074138 | 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 | 030038 | OTHER | ILLINOIS | HEALTH ALLIANCE ID |
| 2 | 050054546 | MEDICARE PIN | ILLINOIS | |
| 3 | 132321800 | OTHER | ILLINOIS | US DEPT OF LABOR GROUP |
| 4 | K15232 | MEDICARE ID-TYPE UNSPECIFIED | ILLINOIS | INDIV ID LOCAL 99 |
| 5 | K28562 | MEDICARE ID-TYPE UNSPECIFIED | ILLINOIS | MC INDIVIDUAL PROVIDER # |
| 6 | E17033 | MEDICARE UPIN | ILLINOIS | |
| 7 | 01608719 | OTHER | ILLINOIS | BLUE CROSS PROVIDER NO. |
| 8 | 050054545 | MEDICARE PIN | ILLINOIS | |
| 9 | K15231 | MEDICARE ID-TYPE UNSPECIFIED | ILLINOIS | INDIVIDUAL ID LOC 16(COOK |
| 10 | 1164451308 | OTHER | ILLINOIS | GL KOEHN ASSOC GROUP NPI |
