Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 125069226 | IL |
NPI | 1053760132 |
---|---|
Provider Name | Dr. John Richgels |
First Address | Burr Ridge, IL 60527-7594 |
Second Address | Chicago, IL 60637-1447 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2016 |
Last Update Date | 08/06/2016 |