Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RN0300X | Nephrologist | IL |
NPI | 1043290265 |
---|---|
Provider Name | Robert Hedger |
First Address | Chicago, IL 60661-5500 |
Second Address | Chicago, IL 60657-6156 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/01/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C38401 | (02) |