Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RE0101X | Endocrinologist (Diabetes Doctor) | 036046532 | IL |
NPI | 1003836503 |
---|---|
Provider Name | Robert W. Kirby |
First Address | Urbana, IL 61801-2530 |
Second Address | Urbana, IL 61801-2530 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2006 |
Last Update Date | 11/06/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1003836503 | NPI (01) | IL |
110063191 | RAILROAD MEDICARE PIN (01) | IL |
C48171 | (02) | IL |