Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 036074960 | IL |
NPI | 1003811035 |
---|---|
Provider Name | Karenmarie Kathleen Meyer |
First Address | Hinsdale, IL 60521-4715 |
Second Address | Hinsdale, IL 60521-4715 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2005 |
Last Update Date | 29/03/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036074960 | (05) | IL |
399980 | MEDICARE GROUP PTAN (01) | IL |
E19183 | (02) | IL |