Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 125.075723 | IL |
N | 111NI0900X | Internist | 125.075723 | IL |
NPI | 1003437443 |
---|---|
Provider Name | Kaitlin Gibson |
First Address | Chicago, IL 60612-3806 |
Second Address | Chicago, IL 60612-3806 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/04/2020 |
Last Update Date | 28/06/2021 |