Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0120X | Pediatric Surgery | 036049256 | IL |
NPI | 1376653568 |
---|---|
Provider Name | Dr. Arthur N. Rettig |
First Address | Rockford, IL 61103-3600 |
Second Address | Rockford, IL 61103-3600 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 27/01/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036049256 | (05) | IL |
C45296 | (02) | IL |