Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | 03663318 | IL |
NPI | 1023090354 |
---|---|
Provider Name | Mary Gloria Kane |
First Address | South Barrington, IL 60010-9115 |
Second Address | South Barrington, IL 60010-9115 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/11/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D15565 | (02) |