Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 125060658 | IL |
NPI | 1013271451 |
---|---|
Provider Name | Dr. Kimberley Jayne Sampson |
First Address | Chicago, IL 60618-8088 |
Second Address | Chicago, IL 60608-1732 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2012 |
Last Update Date | 29/06/2012 |