Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 364024254 | IL |
NPI | 1184793044 |
---|---|
Provider Name | Dr. William G. Klipfel |
First Address | Olympia Fields, IL 60461 |
Second Address | Olympia Fields, IL 60461 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036070219 | (05) | IL |
C51249 | (02) | IL |