Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0003X | Hematology & Oncology | 036-087874 | IL |
NPI | 1063411379 |
---|---|
Provider Name | Dr. Paul A.s. Fishkin |
First Address | Peoria, IL 61615-7822 |
Second Address | Peoria, IL 61615-7822 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2005 |
Last Update Date | 30/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F77114 | (02) |