Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 54091 | MN |
N | 111NI0900X | Internist | 54091 | MN |
Y | 207RI0011X | Interventional Cardiology | 036-132886 | IL |
NPI | 1104147628 |
---|---|
Provider Name | Steven L Driver |
First Address | Chicago, IL 60657-4414 |
Second Address | Chicago, IL 60657-4414 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2010 |
Last Update Date | 14/01/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
ENROLLED | (05) | IA |
ENROLLED | (05) | MN |
ENROLLED | (05) | WI |
P01021783 | RAIL ROAD - MEDICARE (01) | MN |