Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207U00000X | Nuclear Medicine Specialist | 036-079728 | IL |
NPI | 1396780862 |
---|---|
Provider Name | Donald W Trepashko |
First Address | Glenview, IL 60025-3238 |
Second Address | Chicago, IL 60612-3714 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2006 |
Last Update Date | 30/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E12083 | (02) | IL |