Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207K00000X | Allergist & Immunologist | IL | |
N | 207Q00000X | Family Doctor | IL |
NPI | 1164595146 |
---|---|
Provider Name | Richard E Hrdlicka |
First Address | Geneva, IL 60134 |
Second Address | Geneva, IL 60134 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4500621 | BC PROVIDER (01) | |
C45373 | (02) |