Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207SG0201X | Clinical Genetics (M.D.) | 036-103697 | IL |
N | 208000000X | Pediatrician | 036-103697 | IL |
NPI | 1679500292 |
---|---|
Provider Name | Julie Ann Fleischer |
First Address | Springfield, IL 62701-1041 |
Second Address | Springfield, IL 62701-1041 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2006 |
Last Update Date | 21/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036103697 | (05) | IL |