Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | 125077267 | IL |
NPI | 1114597846 |
---|---|
Provider Name | Henry Chill |
First Address | Burr Ridge, IL 60527-6686 |
Second Address | Evanston, IL 60201-1700 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2021 |
Last Update Date | 25/06/2021 |