Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0000X | Hematologist | 036064414 | IL |
NPI | 1154340792 |
---|---|
Provider Name | Martin Tallman |
First Address | Chicago, IL 60611-4546 |
Second Address | Chicago, IL 60611-5975 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2006 |
Last Update Date | 17/07/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C43612 | (02) |