Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207KA0200X | Allergist | 036056538 | IL |
NPI | 1508885385 |
---|---|
Provider Name | G Wendell Richmond |
First Address | Hinsdale, IL 60521-3635 |
Second Address | Hinsdale, IL 60521-3635 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2006 |
Last Update Date | 17/10/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D93444 | (02) | IL |