Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | IL |
NPI | 1013020544 |
---|---|
Provider Name | Timothy D Putnam |
First Address | Oak Brook, IL 60523-3846 |
Second Address | Evergreen Park, IL 60805-2701 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C40732 | (02) | IL |