Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 209001352 | IL |
NPI | 1003993734 |
---|---|
Provider Name | Peter Kale |
First Address | Urbana, IL 61801-2500 |
Second Address | Urbana, IL 61802 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2006 |
Last Update Date | 26/05/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
P82301 | (02) | |
P82301 | (02) | IL |