Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 036-112406 | IL |
NPI | 1013064195 |
---|---|
Provider Name | Joseph Flint |
First Address | Delavan, IL 61734-9619 |
Second Address | Delavan, IL 61734-9619 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/01/2007 |
Last Update Date | 18/05/2012 |