Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 2011018185 | MO |
NPI | 1003104266 |
---|---|
Provider Name | Corrine Heather Hamvas |
First Address | Lake Bluff, IL 60044-2203 |
Second Address | Lake Bluff, IL 60044-2203 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2011 |
Last Update Date | 12/06/2014 |