Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 125078270 | IL |
NPI | 1053986158 |
---|---|
Provider Name | Chandler Nicholas Hudson |
First Address | Springfield, IL 62794-9665 |
Second Address | Springfield, IL 62702-6700 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/05/2021 |
Last Update Date | 21/05/2021 |