Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | IL |
NPI | 1033228549 |
---|---|
Provider Name | Peter S Hallarman |
First Address | Northbrook, IL 60062-7930 |
Second Address | Northbrook, IL 60062-7930 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A74424 | (02) | IL |