Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 52426 | TN |
Y | 207VX0000X | Obstetrician | 036108168 | IL |
NPI | 1053394155 |
---|---|
Provider Name | Roberto Levi-D'ancona |
First Address | Springfield, IL 62702-5131 |
Second Address | Springfield, IL 62702-5238 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/11/2005 |
Last Update Date | 21/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036108168 | (05) | IL |
K02405 | (02) | IL |