Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081P2900X | Pain Medicine | 036091149 | IL |
NPI | 1063521169 |
---|---|
Provider Name | Christopher Rink |
First Address | Bloomington, IL 61704-2101 |
Second Address | Bloomington, IL 61704-2101 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 06/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G26378 | (02) | IL |
IL2613 | MEDICARE GROUP PTAN (01) | IL |