Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | IL |
NPI | 1003847914 |
---|---|
Provider Name | Andrew Coleman |
First Address | Harrisburg, IL 62946 |
Second Address | Harrisburg, IL 62946 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H46117 | (02) | IL |