Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 036070447 | IL |
N | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 036070447 | IL |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 036070447 | IL |
NPI | 1396731014 |
---|---|
Provider Name | John L. Reilly |
First Address | Lisle, IL 60532-3698 |
Second Address | Naperville, IL 60540-8902 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2005 |
Last Update Date | 04/03/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036070447 | (05) | IL |
200013545 | RAILROAD MEDICARE (01) | IL |
E18663 | (02) | IL |