Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RI0200X | Infectious Disease | IL |
NPI | 1023004108 |
---|---|
Provider Name | Roberta Luskin-Hawk |
First Address | Westmont, IL 60559-5511 |
Second Address | Chicago, IL 60657-5640 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/09/2005 |
Last Update Date | 28/01/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1618792 | BCBS PROVIDER ID (01) | IL |
C47453 | (02) | IL |