Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 125058668 | IL |
Y | 111NI0900X | Internist | 125058668 | IL |
NPI | 1003120783 |
---|---|
Provider Name | Dr. Carlos Alberto Urdininea Kirkwood |
First Address | Havana, IL 62644-0530 |
Second Address | Havana, IL 62644-1243 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/08/2010 |
Last Update Date | 27/01/2017 |