Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | 036089684 | IL |
NPI | 1033147848 |
---|---|
Provider Name | Mr. Kenneth Schoenig |
First Address | Normal, IL 61761 |
Second Address | Normal, IL 61761 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2006 |
Last Update Date | 07/09/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036089684 | (05) | IL |
G51900 | (02) |