Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | 125065959 | IL |
NPI | 1003220336 |
---|---|
Provider Name | Ginger Yvonne Clinton |
First Address | Chicago, IL 60612-3765 |
Second Address | Chicago, IL 60612-3765 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2014 |
Last Update Date | 28/07/2014 |