Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111NN0400X | Neurology | 03804476 | IL |
Y | 111NR0400X | Rehabilitation Chiropractor | 03804476 | IL |
NPI | 1801017405 |
---|---|
Provider Name | Dr. Handel A Metcalf |
First Address | Aurora, IL 60507-2601 |
Second Address | Aurora, IL 60507 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2007 |
Last Update Date | 17/02/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0004582052 | BLUE CROSS (01) | IL |
212888 | (05) | IL |