Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0400X | Neurologist | 036053218 | IL |
NPI | 1023043098 |
---|---|
Provider Name | Harry L Bremer |
First Address | Urbana, IL 61803-6002 |
Second Address | Urbana, IL 61801 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2006 |
Last Update Date | 05/06/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036053218 | (05) | IL |
6447860011 | (05) | IL |
C43407 | (02) | |
C43407 | (02) | IL |