Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TH0100X | Health Service |
NPI | 1639321169 |
---|---|
Provider Name | Dr. Eugenie Bournique Pabst |
First Address | Chicago, IL 60614-5090 |
Second Address | Chicago, IL 60614-5090 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/10/2008 |
Last Update Date | 17/10/2008 |