Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | 036-102660 | IL |
NPI | 1003016965 |
---|---|
Provider Name | Robert Marc Abrams |
First Address | Springfield, IL 62794-9640 |
Second Address | Springfield, IL 62702-5303 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2007 |
Last Update Date | 16/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036102660 | (05) | IL |
H88113 | (02) | IL |