Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 036090897 | IL |
NPI | 1063442457 |
---|---|
Provider Name | Finn R Amble |
First Address | Bloomington, IL 61704-4193 |
Second Address | Bloomington, IL 61704 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2006 |
Last Update Date | 21/05/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
040008946 | RAILROAD (01) | IL |
0533210001 | DMERC (01) | |
F13080 | (02) | IL |
IL2613 | MEDICARE GROUP # (01) |