Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | 036097082 | IL |
NPI | 1003826173 |
---|---|
Provider Name | Adrienne Berman |
First Address | Newport Beach, CA 92660-6055 |
Second Address | Chicago, IL 60612-7232 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2006 |
Last Update Date | 18/11/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G04179 | (02) |