Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0400X | Neurologist | 036.129615 | IL |
NPI | 1003077389 |
---|---|
Provider Name | Dr. Austin Hake |
First Address | Quincy, IL 62301-3027 |
Second Address | Quincy, IL 62301-3027 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/06/2008 |
Last Update Date | 26/02/2014 |