Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213EP1101X | Primary Podiatric Medicine | 016-003258 | IL |
Y | 111NR0200X | Radiology | 016-003258 | IL |
Y | 213ER0200X | Radiology | 016-003258 | IL |
NPI | 1609866151 |
---|---|
Provider Name | Dr. Robert Leonard Baron |
First Address | Willowbrook, IL 60527 |
Second Address | Willowbrook, IL 60527-7010 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/10/2005 |
Last Update Date | 01/02/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
016-003258 | STATE LICENSE (01) | IL |
T37002 | (02) | IL |