Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | 036083144 | IL |
N | 207VX0000X | Obstetrician | 036083144 | IL |
NPI | 1285688820 |
---|---|
Provider Name | Mr. Lindsey A Ma |
First Address | Peoria, IL 61614-5098 |
Second Address | Peoria, IL 61614-5098 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2006 |
Last Update Date | 28/12/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
07232118 | BCBS OF ILLINOIS (01) | IL |
F58390 | (02) | IL |
HEALTHLINK | 239068 (01) | IL |
JOHN DEERE | IL0101/203158434-01 (01) | IL |
P00272393/DE1123 | RAILROAD MEDICARE (01) | IL |