Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 036-142459 | IL |
NPI | 1336428010 |
---|---|
Provider Name | Brian Patrick Flanagan |
First Address | Crystal Lake, IL 60012-3709 |
Second Address | Crystal Lake, IL 60012 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2011 |
Last Update Date | 19/10/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036142459 | STATE LICENSE (01) | IL |