Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | 036105585 | IL |
NPI | 1104932326 |
---|---|
Provider Name | Kelly Klingler Newhall |
First Address | Chicago, IL 60614-1798 |
Second Address | Chicago, IL 60614-1798 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/08/2006 |
Last Update Date | 31/08/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036105585 | (05) | IL |