Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NI0013X | Independent Medical Examiner | IL |
NPI | 1356545859 |
---|---|
Provider Name | Kevin D Sager |
First Address | Sumner, IL 62466-1027 |
Second Address | Sumner, IL 62466-1027 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0005122038 | BLUE CROSS BLUE SHIELD (01) | IL |