Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | IL | |
Y | 103TC0700X | Clinical Psychologist | IL |
NPI | 1003890310 |
---|---|
Provider Name | Mr. Robert J Galligan |
First Address | Chicago, IL 60616-2333 |
Second Address | Chicago, IL 60616-2333 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/11/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01621679 | BCBS OF IL (01) | IL |
S 24839 | (02) | IL |