Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | IL |
NPI | 1104975770 |
---|---|
Provider Name | Dr. Daryn Abraham |
First Address | Carol Stream, IL 60188-2756 |
Second Address | Carol Stream, IL 60188-2756 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/01/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H80820 | (02) | IL |