Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 36115374 | IL |
NPI | 1003825662 |
---|---|
Provider Name | Dr. Thomas W Bockle |
First Address | Chicago, IL 60623-2460 |
Second Address | Chicago, IL 60623-2460 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2006 |
Last Update Date | 16/11/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I67110 | (02) | IL |