Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 036088342 | IL |
NPI | 1043205057 |
---|---|
Provider Name | Christopher Reger |
First Address | Chicago, IL 60611-3167 |
Second Address | Chicago, IL 60611-3167 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/09/2005 |
Last Update Date | 06/12/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036088342 | (05) | IL |
P01110874 | RAILROAD MEDICARE (01) | IL |