Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 036081167 | IL |
NPI | 1013224153 |
---|---|
Provider Name | Dr. Rebecca Bower-Lewis |
First Address | Northfield, IL 60093-2702 |
Second Address | Chicago, IL 60612-3723 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/09/2010 |
Last Update Date | 10/09/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G84147 | (02) | IL |