Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0300X | Geriatric Medicine | 036073836 | IL |
NPI | 1033129788 |
---|---|
Provider Name | Chester Durnas |
First Address | Rockford, IL 61114-8055 |
Second Address | Rockford, IL 61114-8055 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/08/2006 |
Last Update Date | 27/05/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E45738 | (02) |