Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | IL |
NPI | 1063426054 |
---|---|
Provider Name | Charles Egley |
First Address | Chicago, IL 60686-0001 |
Second Address | Peoria, IL 61636-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
008414 | HEALTH ALLIANCE (01) | IL |
0360428782 | (05) | IL |
623719 | HEALTHLINK (01) | IL |
7215059 | BCBS PPO (01) | IL |
7777E | RAILROAD MEDICARE (01) | IL |
C83636 | (02) | IL |
IL0148 | JOHN DEERE (01) | IL |