Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | IL |
NPI | 1235149279 |
---|---|
Provider Name | Dr. Glenn Richard Scheive |
First Address | Bloomingdale, IL 60108-1400 |
Second Address | Bloomingdale, IL 60108-1400 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T37930 | (02) | IL |