Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 038.013801 | IL |
NPI | 1679233068 |
---|---|
Provider Name | Dr. Ellie Dilks |
First Address | East Moline, IL 61244-4248 |
Second Address | East Moline, IL 61244-4248 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/12/2021 |
Last Update Date | 27/12/2021 |