Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 211.000278 | IL |
Y | 222Z00000X | Podiatrist | 211.000278 | IL |
N | 224P00000X | Prosthetist | 213.000264 | IL |
NPI | 1396246930 |
---|---|
Provider Name | Angela Bauer |
First Address | Oakbrook Terrace, IL 60181-3985 |
Second Address | Skokie, IL 60077-4407 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/02/2018 |
Last Update Date | 27/02/2018 |