Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 038.012384 | IL |
Y | 111NI0900X | Internist | 038.012384 | IL |
NPI | 1003252974 |
---|---|
Provider Name | Dr. Kalli Ann Prater |
First Address | St Charles, IL 60174-1912 |
Second Address | St Charles, IL 60174-1912 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2013 |
Last Update Date | 17/05/2013 |