Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XM0800X | Mental Health | 056002356 | IL |
NPI | 1295064806 |
---|---|
Provider Name | Mr. James Fredric Hill |
First Address | Riverside, IL 60546-2224 |
Second Address | Chicago, IL 60612-7232 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/12/2009 |
Last Update Date | 09/12/2009 |