Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 036128757 | IL |
NPI | 1124260625 |
---|---|
Provider Name | Sonia Wengerhoff |
First Address | Chicago, IL 60657-5081 |
Second Address | Chicago, IL 60657-5081 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/03/2009 |
Last Update Date | 18/05/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036128757 | (05) | IL |