Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | 01061790A | IN |
Y | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | 036-118042 | IL |
NPI | 1134200611 |
---|---|
Provider Name | Richard L Meisel |
First Address | Springfield, IL 62702-5131 |
Second Address | Springfield, IL 62702-5310 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/10/2006 |
Last Update Date | 16/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01061790A | LICENSE NUMBER (01) | IN |
036118042 | (05) | IL |
0533210001 | DMERC (01) | IL |
205023387 | TAX ID# (01) | IN |
E79552 | (02) | IL |