Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0131X | Foot Surgery | IL |
NPI | 1285636795 |
---|---|
Provider Name | Dr. Warren Ian Hastings |
First Address | Olympia Fields, IL 60461-1862 |
Second Address | Olympia Fields, IL 60461-1862 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/08/2005 |
Last Update Date | 01/04/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0060000846 | BCBS (01) | IL |
T36918 | (02) | IL |