Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PP0204X | Pediatric Emergency Physician | 036138236 | IL |
N | 208000000X | Pediatrician | 036138236 | IL |
NPI | 1336328145 |
---|---|
Provider Name | Dr. Erin Marie Augustine |
First Address | Chicago, IL 60611-2991 |
Second Address | Chicago, IL 60611-2991 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/10/2007 |
Last Update Date | 09/04/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036138236 | (05) | IL |
F400386486 | PTAN (01) |