Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 036048494 | IL |
NPI | 1013990274 |
---|---|
Provider Name | Dr. Robert John Pines |
First Address | Barrington, IL 60010 |
Second Address | Barrington, IL 60010 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/11/2005 |
Last Update Date | 14/02/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
36048494 | (05) | IL |
D14278 | (02) |