Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 036081888 | IL |
NPI | 1003801499 |
---|---|
Provider Name | Dr. David J Bitzer |
First Address | Effingham, IL 62401-2193 |
Second Address | Effingham, IL 62401-2193 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/09/2005 |
Last Update Date | 28/02/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036081888 | (05) | IL |
F30160 | (02) |