Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RN0300X | Nephrologist | 036051932 | IL |
NPI | 1063542751 |
---|---|
Provider Name | Frederick Horvath |
First Address | Peoria, IL 61603-3089 |
Second Address | Peoria, IL 61603-3089 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/03/2007 |
Last Update Date | 11/12/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036051932 | (05) | IL |
390001119 | BCBS (01) | IL |
390001119 | RAILROAD MEDICARE (01) | IL |
C39824 | (02) | IL |