Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 036-112774 | IL |
Y | 2080P0207X | Pediatric Hematology-Oncologist | 036-112774 | IL |
NPI | 1063406825 |
---|---|
Provider Name | Dr. Rebecca E Mcfall |
First Address | Oak Lawn, IL 60453-2600 |
Second Address | Oak Lawn, IL 60453-2600 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/09/2005 |
Last Update Date | 28/12/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
021622158 | BLUE SHIELD GROUP NUMBER (01) | IL |
036112774 | (05) | IL |
I34458 | (02) | IL |