Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0000X | Obstetrician | IL |
NPI | 1407962079 |
---|---|
Provider Name | Dr. Thomas A Herriges |
First Address | Evanston, IL 60202-3439 |
Second Address | Evanston, IL 60202-3439 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
BCBS | 31602467 (01) | IL |
D16509 | (02) | IL |