Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RN0300X | Nephrologist | 042008047 | IL |
NPI | 1033270533 |
---|---|
Provider Name | Dr. David L Mcfadden |
First Address | Orland Park, IL 60462-1989 |
Second Address | Joliet, IL 60435-6576 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/12/2006 |
Last Update Date | 18/05/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036087527 | (05) | IL |
390004585 | PALMETTO RR MEDICARE (01) | IL |
9908151 | BLUE CROSS BLUE SHIELD (01) | IL |