Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | 036-087141 | IL |
NPI | 1023045606 |
---|---|
Provider Name | Dr. Richard Sabbun |
First Address | Chicago, IL 60689-0001 |
Second Address | Bloomington, IL 61701-4364 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2006 |
Last Update Date | 14/07/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
05721369 | BC/BS (01) | IL |
F65233 | (02) | IL |
P00442511 | RAILROAD MEDICARE (01) | IL |