Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 125.056861 | IL |
N | 208600000X | Surgeon | 125.056861 | IL |
N | 2086S0127X | Trauma Surgeon | 55953 | TN |
Y | 2086S0127X | Trauma Surgeon | 69775 | WI |
NPI | 1194051987 |
---|---|
Provider Name | Jill Richman Streams |
First Address | Milwaukee, WI 53226-3522 |
Second Address | Nashville, TN 37212 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/10/2009 |
Last Update Date | 19/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
125.056861 | ILLINOIS STATE MEDICAL LICENSE (01) | IL |
55953 | TENNESSEE STATE MEDICAL LICENSE (01) | TN |