Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0000X | Internist - Cardiovascular Disease | 036-060357 | IL |
NPI | 1023128113 |
---|---|
Provider Name | Thomas B. Cahill JR. |
First Address | O Fallon, IL 62269-1282 |
Second Address | O Fallon, IL 62269-1282 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 21/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036060357 | (05) | IL |
C42340 | (02) | IL |