Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 036132078 | IL |
NPI | 1013146596 |
---|---|
Provider Name | Rebekah Osgood |
First Address | Chicago, IL 60611-8700 |
Second Address | Chicago, IL 60611-8700 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2009 |
Last Update Date | 22/10/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
125055889 | TEMPORARY LICENSE NUMBER (01) | IL |