Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | 036-095221 | IL |
NPI | 1083600415 |
---|---|
Provider Name | Robin Marie Bowman |
First Address | Chicago, IL 60678-0001 |
Second Address | Chicago, IL 60614-3363 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2005 |
Last Update Date | 07/02/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036095221 | (05) | IL |
1627123 | BCBS PROVIDER ID (01) | IL |
363283051 | OWCP PROVIDER ID (01) | IL |
61704100 | (05) | WI |
8278764 | (05) | WA |
G53579 | (02) | IL |