Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 036-074835 | IL |
N | 111NI0900X | Internist | 036-074835 | IL |
Y | 207RH0002X | Hospice and Palliative Medicine | 036-074835 | IL |
NPI | 1366492324 |
---|---|
Provider Name | Dr. Martha L. Twaddle |
First Address | Libertyville, IL 60048-9460 |
Second Address | Glenview, IL 60025-7635 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2006 |
Last Update Date | 23/07/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036-074835 | (05) | IL |
E24564 | (02) | IL |