Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 038-005346 | IL |
NPI | 1548307523 |
---|---|
Provider Name | Gregory D Thurston |
First Address | Libertyville, IL 60048-0178 |
Second Address | Elmwood Park, IL 60707-4302 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/01/2007 |
Last Update Date | 29/04/2015 |