Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0000X | Obstetrician | 036149752 | IL |
NPI | 1215382999 |
---|---|
Provider Name | Marianne Catherine Krupka |
First Address | Huntley, IL 60142-9526 |
Second Address | Huntley, IL 60142-9526 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/04/2016 |
Last Update Date | 17/08/2020 |