Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RN0300X | Nephrologist | 36038789 | IL |
NPI | 1033104807 |
---|---|
Provider Name | John P Freeland |
First Address | Waukegan, IL 60085-3676 |
Second Address | Waukegan, IL 60085-3600 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/09/2005 |
Last Update Date | 14/07/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036038789 | (05) | IL |
C37545 | (02) | IL |