Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 036067790 | IL |
NPI | 1003886094 |
---|---|
Provider Name | Daniel Lee Houlihan |
First Address | Rockford, IL 61107-5339 |
Second Address | Rockford, IL 61107-5339 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/01/2006 |
Last Update Date | 19/11/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036067790 | (05) | IL |
E18637 | (02) | IL |