Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0200X | Critical Care Medicine | 36082721 | IL |
Y | 207RP1001X | Pulmonary Disease | 36082721 | IL |
NPI | 1083618417 |
---|---|
Provider Name | Dr. Scott Porter Neeley |
First Address | Chicago, IL 60657-6158 |
Second Address | Chicago, IL 60657-6158 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2005 |
Last Update Date | 16/06/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
36082721 | (05) | IL |
F79214 | (02) | IL |