Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 036110454 | IL |
Y | 207QA0401X | Family Doctor - Addiction Medicine | 036110454 | IL |
NPI | 1396739462 |
---|---|
Provider Name | Dr. Katherine M Austman |
First Address | Gibson City, IL 60936-1477 |
Second Address | Gibson City, IL 60936-2000 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/09/2005 |
Last Update Date | 11/10/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036110454 | (05) | IL |
I18127 | (02) | IL |