Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 019021396 | IL |
Y | 1223E0200X | Endodontist | 021001922 | IL |
N | 1223G0001X | General Practice | 021001922 | IL |
N | 213EG0000X | General Practice | 021001922 | IL |
NPI | 1063763761 |
---|---|
Provider Name | Dr. Linda M Sommercorn |
First Address | Libertyville, IL 60048-4898 |
Second Address | Libertyville, IL 60048-3940 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2012 |
Last Update Date | 08/09/2015 |