Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | IL |
NPI | 1104997030 |
---|---|
Provider Name | Carlotta M Rinke |
First Address | Naperville, IL 60540-7645 |
Second Address | Elk Grove Village, IL 60007-3311 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D15857 | (02) | IL |