Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | IL |
NPI | 1043204043 |
---|---|
Provider Name | Dr. Philip Nagel |
First Address | Lake Barrington, IL 60010 |
Second Address | Lake Barrington, IL 60010 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/09/2005 |
Last Update Date | 07/09/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C43152 | (02) |