Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | 036-106198 | IL |
NPI | 1164462248 |
---|---|
Provider Name | Joseph Stock |
First Address | Ann Arbor, MI 48105-1598 |
Second Address | Chicago, IL 60610-3288 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2006 |
Last Update Date | 03/06/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036106198-1 | (05) | IL |
DB9340 | MEDICARE RAILROAD (01) | IL |
H75286 | (02) | IL |
P00177284 | MEDICARE RAILROAD (01) | IL |