Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0300X | Geriatric Medicine | 036072219 | IL |
NPI | 1033237789 |
---|---|
Provider Name | Brendan Michael Reilly |
First Address | Chicago, IL 60612 |
Second Address | Chicago, IL 60612-3714 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2007 |
Last Update Date | 08/07/2007 |