Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 070003876 | IL |
NPI | 1003085119 |
---|---|
Provider Name | Caroline M Sobon |
First Address | Chicago, IL 60606-1216 |
Second Address | Carol Stream, IL 60188-2793 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/02/2008 |
Last Update Date | 03/12/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1619908 | BCBS IL GROUP NUMBER (01) | IL |
1623066 | BCBS PROVIDER # (01) | IL |
200852 | MEDICARE GROUP # (01) | IL |
202542 | MEDICARE GROUP # (01) | IL |
367885100 | U. S. DEPT OF LABOR (01) | IL |