Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RH0000X | Hematologist | 036102484 | IL |
Y | 207RX0202X | Medical Oncology | 036102484 | IL |
NPI | 1053342428 |
---|---|
Provider Name | Ginny Kamboj |
First Address | Mchenry, IL 60050-7012 |
Second Address | Mchenry, IL 60050-7012 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2006 |
Last Update Date | 11/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H25576 | (02) |