Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 125055487 | IL |
NPI | 1003058736 |
---|---|
Provider Name | Angela Mccormick |
First Address | Park Ridge, IL 60068-2675 |
Second Address | Park Ridge, IL 60068-2675 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/03/2009 |
Last Update Date | 06/06/2013 |